# Exacerbation of Cerebellar Symptoms in Spinocerebellar Ataxia Induced by Lamotrigine: A Case Report

## TL;DR

A patient with cerebellar ataxia experienced worsened symptoms after taking lamotrigine, highlighting the drug's potential neurological side effects.

## Contribution

This case report highlights lamotrigine's potential to exacerbate cerebellar symptoms in patients with progressive cerebellar ataxia.

## Key findings

- Lamotrigine use was associated with worsened cerebellar symptoms, including tremor and gait disturbance.
- Symptoms improved after lamotrigine dose reduction and discontinuation.
- The case suggests a possible link between lamotrigine and cerebellar dysfunction in progressive ataxia.

## Abstract

We describe a case of exacerbation of cerebellar symptoms following lamotrigine (LTG) treatment in a patient with the pure cerebellar type of spinocerebellar ataxia (SCA). A 16-year-old female, initially diagnosed with cerebellitis, developed progressive cerebellar ataxia despite treatment. At age 20, she was diagnosed with cerebellitis sequelae and tested positive for anti-NH2-terminal of α-enolase (anti-NAE) antibodies, leading to a diagnosis of cerebellar ataxia-type Hashimoto's encephalopathy. Steroid therapy provided minimal benefit, and her ataxic symptoms worsened. At age 28, a neurological examination revealed multiple cerebellar signs and significant cerebral and brainstem atrophy on magnetic resonance imaging. Due to persistent symptom progression, she was diagnosed with pure cerebellar SCA at age 30. At age 33, LTG, initiated for a mood disorder, exacerbated her cerebellar symptoms, including a new-onset tremor, downbeat nystagmus, and gait disturbance. Symptom improvement was observed following LTG dose reduction and discontinuation, suggesting LTG's influence on cerebellar function. This report discusses the effects of LTG on neurological symptoms and highlights the potential neurological side effects of LTG in a patient with progressive cerebellar ataxia, emphasizing the importance of careful medication management in neurological disorders.