BackgroundOptimal anti-epileptic drug (AED) treatment maximises therapeutic
response and minimises adverse effects (AEs). Key to therapeutic AED
treatment is adherence. Non-adherence is often related to severity of
AEs. Frequently, patients do not spontaneously report, and clinicians do
not specifically query, critical AEs that lead to non-adherence,
including sexual dysfunction. Sexual dysfunction prevalence in patients
with epilepsy ranges from 40 to 70%, often related to AEDs, epilepsy or
mood states. This case reports lamotrigine-induced sexual dysfunction
leading to periodic non-adherence.AimsTo report lamotrigine-induced sexual dysfunction leading to periodic
lamotrigine non-adherence in the context of multiple comorbidities and
concurrent antidepressant and antihypertensive pharmacotherapy.MethodCase analysis with PubMed literature review.ResultsA 56-year-old male patient with major depression, panic disorder without
agoraphobia and post-traumatic stress disorder was well-controlled with
escitalopram 20 mg bid, mirtazapine 22.5 mg qhs and alprazolam 1 mg tid
prn. Comorbid conditions included complex partial seizures, psychogenic
non-epileptic seizures (PNES), hypertension, gastroesophageal reflux
disease and hydrocephalus with patent ventriculoperitoneal shunt that
were effectively treated with lamotrigine 100 mg tid, enalapril 20 mg qam
and lansoprazole 30 mg qam. He acknowledged non-adherence with
lamotrigine secondary to sexual dysfunction. With lamotrigine 300 mg
total daily dose, he described no libido with
impotence/anejaculation/anorgasmia. When off lamotrigine for 48 h, he
described becoming libidinous with decreased erectile dysfunction but
persistent anejaculation/anorgasmia. When off lamotrigine for 72 h to
maximise sexual functioning, he developed auras. Family confirmed
patient's consistent monthly non-adherence for 2–3 days during the past
year.ConclusionsSexual dysfunction is a key AE leading to AED non-adherence. This case
describes dose-dependent lamotrigine-induced sexual dysfunction with
episodic non-adherence for 12 months. Patient/clinician education
regarding AED-induced sexual dysfunction is warranted as are routine
sexual histories to ensure adherence.
Sexual Dysfunction Related to Multiple Sclerosis: Literature Review