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New research raises questions about prescribing anti-convulsants for various symptoms in people with MS

7th June 2010
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New research raises questions about prescribing anti-convulsants for various symptoms in people with MS A new study from one of the world's leading neurology hospitals, the National Hospital for Neurology and Neurosurgery in Queen's Square London, has raised doubts about the common practice by neurologists of prescribing anti-convulsant medication for pain and other symptoms in people with MS. For some years, doctors treating people with MS have prescribed drugs such as Tegretol, Neurontin, and Lamictal for such various problems in people with MS as pain and spasticity. These drugs were developed as anti-convulsant medications, that is they were designed to be used to stop epileptic seizures. But we know from court testimony for at least one of the drugs, gabapentin, that drug companies have aggressively marketed them as all-purpose restorative drugs for such things as pain and mood disturbance, leading to their wide prescription for these so-called 'off-label' conditions, that is not the primary condition for which they were licensed. Often there has been little or no solid research evidence to support such prescribing.

Now a new study has examined the proposed role of lamotrigine, a new generation anti-convulsant, for so-called neuroprotection, that is, its potential to protect cells in the nervous system against damage from a variety of sources. It was thought that this drug might be a valuable treatment option to protect people with MS against the damage to the brain that occurs with the disease. In fact, the results surprisingly showed that the group receiving lamotrigine had more brain shrinkage during the study than the group receiving placebo. Brain shrinkage or atrophy has been known to represent loss of nerve cells due to the MS disease process. Further, the lamotrigine group had more deterioration of walking and balance related to increasing drug doses than the placebo group. It was also surprising to see that when the study finished, the brain shrinkage partially corrected itself in the lamotrigine group. The reason for these changes is not known, but it does appear that this particular anti-convulsant is not helpful for people with MS, and the study raises questions about the widespread practice of using anti-convulsants for a variety of MS symptoms when little is known of their complex effects on the central nervous system.

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