Abstracts

Rationale: In patients with brain tumors the frequency of epilepsy varies between 30 and 70% and depends on the tumor type, with slowly growing tumors being the most epileptogenic. Lacosamide is a new AED that has a novel mechanism of action which involves selective enhancement of the slow inactivation of voltage-gated sodium channels. It was developed for adjunctive treatment of partial onset seizures in adults over 17 years of age. Methods: A retrospective chart review was performed. Twenty six brain tumor patients from three institutions were analyzed for variables including: age, gender, dosing, seizure frequency at baseline and after initiation of treatment, number of AEDs prior to addition of lacosamide, tumor histology, and side effects. Results: Patients included eight females and eighteen males with an average age of 44 years (range 22-70). Thirty-eight percent of patients had oligodendroglioma and 23% had glioblastoma. On average, patients were receiving two AEDs prior to the addition of lacosamide. Median dose of lacosamide was 200 mg daily (range 100 - 700 mg/day). Physicians reported improvement in seizure frequency in 42% of the patients, with seizure freedom in 23%. Lacosamide was used as monotherapy for two patients. Reported side effects included: headaches, dizziness, tremors, mood changes, somnolence, unsteady gait, fatigue, dyspnea, arthralgias, jaw pain and visual changes. Conclusions: Although limited, the experience in brain tumor patients with refractory seizures reveals applicability of lacosamide as an add-on therapy and, in selected cases as monotherapy.