Abstracts

Rationale: The aim of this unicentre-study was to explore the effectiveness and tolerability of antiepileptic add-on therapy with lacosamide in 26 patients with refractory partial epilepsy after a treatment period of at least 12 weeks. Methods: The data of 26 patients with pharmacoresistant partial epilepsy treated with lacosamide were studied. Observation period was at least 12 weeks. The clinical course under treatment with lacosamide was documented. Effectiveness was evaluated by comparing the seizure frequency with limitations to the countability between 12-week baseline and the observation period after reaching the final dosis. Results: The study population consisted of 26 adult patients (mean age: 36,2 years, range: 18-83 years) with pharmacoresistant partial epilepsy (11 symptomatic and 15 cryptogenic). Six patients (23,1%) underwent epilepsy surgery and 7 patients (26,9%) had vagus nerve stimulation therapy in history. The mean number of antiepileptic drugs (AED) previously used was 8,9 (range 3-15 AED). Concomitant antiepileptic therapy with a mean number of 2,6 AED (range 1-5 AED) was continued in all patients with modification of at least one antiepileptic drug in 13 patients (50%) during the observation period. Add-on therapy with lacosamide was usually initiated with 50 mg twice a day and weekly increased in 100 mg steps. A mean final dose of 385 mg/day (range: 200-750 mg/day) was generally achieved within four weeks. After a treatment period of at least 12 weeks 2 patients (7,7%) were free of seizures, 14 patients (53,8%) had a ≥ 50 % reduction in countable seizures and 10 patients (38,5%) showed no response to the new anticonvulsant drug therapy. One patient (3,9%) described a positive effect on the intensity and duration of the seizures but no reduction in seizure frequency. In 3 patients (11,5%) lacosamide was discontinued due to ineffectiveness. Thirteen patients (50%) experienced mild adverse events such as fatigue (26,9%), nausea (19,2%), gait uncertainty and droughty eyes (each one patient, 3,9%). In 4 patients (15,4%) the dosage of lacosamide therefore had to be decreased slightly what leads to regression of the symptoms in all patients but in no patient therapy with lacosamide was discontinued due to severe adverse events. The patients satisfaction was quoted as high in 12 patients (46,1%), moderate in 4 patients (15,4%) and low in 10 patients (38,5%). Conclusions: Our data suggest that lacosamide may be effective and well tolerated in the antiepileptic add-on therapy of pharmacoresistent partial epilepsies in adult patients. Study results and experience of other authors are confirmed by these data.