Abstracts

Rationale: Up to now more than 35 % of patients with focal epilepsies are still drug resistant. Therefore there is a further need of antiepilectic drugs with different mode of actions. Lacosamide, D-Serin Analogon, is marketed in Germany in October 2008. We report about the early clinical experience in 55 patients so far drug resistant and difficult to treat. Methods: This is a prospective open study. Study targets were the change of seizure frequency, tolerability and quality of life. Measures were the seizure diary, a grading scale of tolerability, Quolie 31 and the retention rate. 55 patients were included (28 female, 27 male). Average duration of the epilepsy was 23 years. 60% temporal lobe epilepsies, 35% frontal and 5% occipital. The average amount of pre study drugs was 9.5. 35% patient were on monotherapy, 50% of two drugs and 16% had more than two drugs. The observation time was between 104 and 145 days. Results: 10 patients were responder with 4 seizure free patients. 4 additional patients had less than 50% seizure reduction. 31 patient were unchanged. There was no correlation between serum level of Lacosamide and mode of response. 30 patients (55%) had adverse events (no severe, 14 relevant and 16 slight). Predominant adverse events were dizziness (16), sleepiness (15), blurred vision (10). 4 patients had allergic exanthema. Inter-individually there was no correlation between grading of side effects and serum level of Lacosamide but intra-individually. Conclusions: This study gives a first impression about the effect of Lacosamide in difficult to treat epilepsies. In this patient group Lacosamide adds 20% more responder with 7.3% seizure free patients. The most frequent side effects are related to the mode of action. Additionally the study indicates a pharmaco-dynamic effect of Lacosamide and the co-medication. The tolerability is improved by slow drug increase, reduction of the basic medication and in some cases reduction of Lacosamide.