Sindromul Stevens-Johnson (SJS), o urgență dermatologică este o

afecțiune rară ; cu o incidență raportată de aproximativ 2,6 pâ nă la 6,1

cazuri la un milion de oameni pe an, cu o rată a mortalită ții de
aproximativ 5%. SJS poartă numele a doi pediatri americani, Albert
Mason Stevens și Frank Chambliss Johnson, care au publicat împreună
prima descriere a tulbură rii în Jurnalul American de Boli ale Copiilor în
1922.

Reacțiile de hipersensibilitate pot apărea la aproape toate medicamentele antiepileptice, cu reacții

adverse cutanate care apar la 3 până la 10% dintre pacienți și erupții cutanate care se dezvoltă de
obicei în primele câteva săptămâni la un număr mic de pacienți.
Sindromul Stevens-Johnsons (SJS) este o reacție de hipersensibilitate mediată de complexul
imun și a fost asociată ca reacții adverse la multe medicamente. Lamotrigina, un medicament
anticonvulsiv și, de asemenea, un stabilizator de dispoziție utilizat în mod obișnuit în pediatrie,
poate fi asociat cu această reacție adversă. Riscul de a dezvolta SJS cu Lamotrigine este rar și
relativ previzibil în primele câteva săptămâni de utilizare. De asemenea, s-a menționat că SSJ se
poate transforma în necroliză epidermică toxică (TEN) mai severă. Deși acest lucru nu a fost
raportat foarte frecvent, SSJ are o mortalitate și morbiditate ridicate și necesită o atenție
deosebită, deoarece utilizarea lamotriginei este în creștere în practica clinică.

Shama Parveen, M. Afzal Javed MA. Stevens Johnson Syndrome associated with Lamotrigine. Pak J Med Sci
2013. 29(6): 1450-1452. doi: 10.12669/pjms.296.4385

Au existat 486 de rapoarte de SJS/TEN la pacienții pediatrici tratați cu

LTG. Nouăzeci și șapte la sută din cazurile cu informații complete cu privire la
timpul până la debutul SJS/TEN au apărut în decurs de 8 săptămâni de la
inițierea terapiei LTG. Timpul median până la debut a fost de 15 zile (IQR: 10-22
zile). Proporția de SJS/TEN cu co-raportare LTG și acid valproic (VPA) a fost
semnificativ mai mare decât ADR necutanat (43% față de 19%, (logOR: 1,60 (IC
99%: 1,33 până la 1,84)).
Rezultatele sugerează că co-medicația VPA cu terapia LTG este un factor de risc
pentru SJS/NET în populația pediatrică. Deși această relație a fost identificată
din rapoartele de caz individuale, acesta este primul studiu de susținere dintr-o
compilație mare de cazuri. Riscul de SJS/TEN este cel mai mare în primele 8
săptămâni de tratament cu LTG la copii, iar medicii trebuie să fie conștienți de
acest risc în această perioadă.
Egunsola O, Star K, Juhlin K, et al. Retrospective review of paediatric case reports of Stevens-Johnson
syndrome and toxic epidermal necrolysis with lamotrigine from an international pharmacovigilance
database. BMJ Paediatrics Open 2017;1:e000039.
doi:10.1136/ bmjpo-2017-000039

Setarea bazelor de date EMBASE (1974–aprilie 2015), MEDLINE (1946–aprilie

2015), PubMed și biblioteca Cochrane pentru studii controlate randomizate au
fost căutate pentru studii privind siguranța lamotriginei.
Participanți Au fost incluse toate studiile care au implicat copii și adolescenți cu
vârsta ≤ 18 ani care au primit cel puțin o singură doză de lamotrigină, având ca
măsură de rezultat siguranța.
Măsuri de rezultat primar și secundar Măsura de rezultat primară a fost
siguranța lamotriginei. Interacțiunea medicamentoasă a lamotriginei a fost
rezultatul secundar.
Rezultate Au fost identificate un total de 78 de articole care au implicat 3783 de
copii. Au fost raportate 2222 de evenimente adverse (AE).

Egunsola O, Choonara I, Sammons HM. Safety of lamotrigine in paediatrics: a systematic review. BMJ
Open 2015;5: e007711. doi:10.1136/ bmjopen-2015-007711

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