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(Abst. 2.159), 2010

Role of Lacosamide as Adjunctive Treatment of Adults with Primary Generalized Epilepsy
Authors: Pegah Afra, L. Strom, J. Bainbridge, T. Buchanan, A. Berry and M. Spitz
Content: Rationale: Lacosamide is approved for adjunctive treatment of partial onset epilepsies. The role of lacosamide in treatment of primary generalized epilepsies (PGEs) is not known. Here we present a heterogeneous group of patients with pharmaco-resistant PGEs who were treated with lacosamide add on therapy. Methods: We present a heterogonous group of 10 patients with pharmacoresistent generalized epilepsy who had adjunctive treatment with lacosamide. This heterogeneous group included four patients with primary generalized tonic clonic seizures, one patient with juvenile absence epilepsy, three patients with juvenile absence epilepsy and generalized tonic clonic seizures, and two patients with atypical absence epilepsy. Clinical characteristics (including age of onset, seizure type, and neurophysiologic characteristic of interictal epileptiform discharges) are summarized in table-1. All patients had normal background EEG, and normal MRI. Eight patients had normal cognitive functions. One patient had mild mental retardation and one patient had learning disability. Results: The four patients who had primary generalized tonic clonic seizures responded to lacosamide adjunctive therapy in the range of 400-600 mg/day. One of the four patients became seizure-free, and two patients had marked decrease in seizure frequency. One patient maintained seizure freedom during and after switch-over to lacosamide (from felbamate due side effects). Our only patient with juvenile absence epilepsy became seizure free shortly after initiation of lacosamide. She developed an allergic blotchy rash that resulted in discontinuation of lacosamide in the 6th week of treatment. Following discontinuation she had emergence of absence clusters. In the three patients with absence epilepsy with generalized tonic clonic seizures, one became seizure free on high doses of lacosamide 600-700 mg/d, one had no further generalized seizure and decrease in frequency of absence seizures. One patient had no response to this medication but became seizure free on Depakote monotherapy. Neither of the two patients with atypical absence epilepsy had any improvement in their seizure frequency while on lacosamide adjunctive therapy. Conclusions: Our retrospective data suggests that lacosamide may have a role in adjunctive treatment of pharmaco-resistant primary generalized epilepsies. There is a suggestion that higher doses of lacosamide up to 700 mg/d may be needed for effectiveness. More studies are needed to determine the exact role of this medication and its true spectrum of action.
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