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(Abst. 2.206), 2010

Adjunctive treatment with Lacosamide: an option for generalized epilepsy ?
Authors: Stephan Arnold and A. Beige
Content: Rationale: Lacosamide (LCM) was licensed in Germany for the treatment of focal epilepsy in September 2008. We investigated the efficacy and tolerability in 10 patients with idiopathic generalized epilepsy who failed at least 3 of 4 approved antiepileptic drugs (valproate, lamotrigine, topiramate, levetiracetam) and subsequently received LCM 100 - 300 mg/d as off-label adjunctive treatment. This is the first report on LCM exposure for more than six months in this group of patients. Methods: Ten consecutive patients (6 females, 4 males, 20 - 62 years) were included. Syndrom diagnosis was based on seizure semiology, EEG findings and absence of structural lesions (5 cases of juvenile myoclonic epilepsy, 2 cases of grand-mal epilepsy and 3 cases of absence epilepsy). Previous treatment included valproate (all 10 patients), lamotrigine and levetiracetam in 9 patients and topiramate in 7 patients. All patients experienced at least 3 generalized tonic-clonic seizures (GTCS) within the 12-months period prior to LCM treatment (range 3 - 19 GTCS within 12 months). Efficacy was calculated comparing the seizure frequency on treatment with LCM to the 12 months before LCM treatment. Assessment of tolerability was obtained from patient reports and neurological examinations. Results: Three patients stopped LCM due to side effects (tiredness, n=2) and lack of efficacy (n=2). The remaining seven patients have been treated with LCM add-on for 7 - 20 months so far. Two patients are seizure-free since starting LCM (for 16 and 20 months, respectively). Both patients experienced 12 GTCS during the 12 months before starting LCM. Three further patients showed > 75% and two patients > 50 % seizure reduction of GTCS. No increase in GTC seizure frequency was observed in any patient. One patient experienced an intermittent and self-limiting increase of generalized myoclonic seizures. No increase of absence seizures was reported. Tiredness was the most common side effect (4 of 10 patients). Concomitant AED medication was stepwise reduced according to the patients needs. Currently one patient is on LCM monotherapy treatment. Conclusions: Lacosamide may be a good option for adjunctive treatment of generalized epilepsies. LCM is well tolerated in most patients. A randomized, double-blind, placebo-controlled trial should be established to further evaluate the potential of adjunctive LCM treatment in generalized epilepsies.