Abstracts

Rationale: Lacosamide (LCS) is a novel antiepileptic drug (AED) with potential benefit as adjunctive treatment in patients with partial-onset seizures1-3. The cognitive effects have, as yet, not been studied. In this open clinical prospective study the cognitive effects of LCS when used as adjunctive antiepileptic therapy in patients with epilepsy was evaluated. Methods: We included 33 patients (24 females, 9 males) aged between 16-74 years (mean 37 years sd:14.5). All patients had a localisation-related epilepsy (42% cryptogenic; 58% symptomatic). Patients were assessed at baseline before starting treatment and at follow-up when the optimal clinical dose was achieved. Patients were using LCS treatment with a daily dose between 100 to 600 mg (mean daily dose of 298.2 mg/day). Mean follow-up time was 7 months (range 1-24). Patients were treated with up to four concomitant AEDs (mean: 1.9). Subjective complaints were evaluated using the SIDAED (subjective list of 46-items with possible AED-related complaints); effects on cognition were evaluated using the CVST, a test measuring speed of central information processing (‘mental speed'). Results: The CVST showed significant faster information processing reaction times at the second evaluation (p=.013). On the SIDAED, patients complained more about their cognitive function at the second evaluation (p=.002). Conclusions: Lacosamide has a positive effect on the information processing speed. As this is the most sensitive function for effects of AEDs, LCS does not seem to induce negative cognitive effects. Remarkably patients complained more, especially about their cognitive function. This ‘doing better, feeling worse' phenomenon is well described in e.g. mild cognitive impairment and in traumatic brain injury. Here this discrepancy can be caused by the deepened worries of patients when ending a trial (losing extra attention).