To explore whether chorea may be associated with lamotrigine use and compile a literature review of clinical characteristics of patients diagnosed with lamotrigine-associated chorea.  

We performed a retrospective chart review of all patients diagnosed with chorea who had concurrent use of lamotrigine between 2000-2022. The timing of lamotrigine use was mapped to the onset of chorea. Demographic information and clinical characteristics were analyzed, including medical comorbidities and concurrent centrally acting medications. A literature search and review were conducted, with additional cases of lamotrigine-associated chorea analyzed.

Eight patients met the inclusion criteria for the retrospective review. In 7 of the 8 patients, other causes of chorea were considered more likely, including chorea prior to lamotrigine initiation (n=3), chorea related to antihistamine use (n=1), Tourette’s syndrome (n=1), an underlying viral infection (n=1), and drug-induced parkinsonism (n=1). However, a 58-year-old woman with bipolar disorder on lamotrigine for mood stabilization had a clear association of chorea induced by lamotrigine. Dose escalations of lamotrigine led to increased chorea severity, while tapering the medication reduced hyperkinetic movements. The patient was also on multiple centrally active medications: bupropion, duloxetine, gabapentin, and trazadone. Three additional cases of lamotrigine-associated chorea were identified through a literature review. In 2 of these cases, other centrally acting agents were used, and chorea resolved with weaning lamotrigine.

Chorea is infrequently seen in the setting of lamotrigine use. In these rare cases, the presence of other centrally acting medications with lamotrigine may be contributing to chorea.