Abstracts

Rationale: Postmarketing experience suggests that lacosamide (LCM) may be particularly useful in controlling seizures emerging from sleep. The objective of this study was to evaluate the efficacy and safety of LCM in the treatment of nocturnal seizures. Methods: We reviewed the clinical charts of all patients with epilepsy presenting seizures emerging exclusively or almost exclusively (>90%) from sleep that had been treated with at least one dose of LCM. Only patients with a reliable account of their seizures (self-reported or witnessed) were included. Efficacy was assessed at months 6 and 12 by comparing pre-LCM monthly seizure frequency with post-LCM treatment seizure frequency. Pre-treatment monthly seizure frequency was assessed during a 12-month retrospective baseline prior to introduction of LCM. A 3-month dose-adjustment period was excluded for seizure frequency analysis. Response was defined as >50% reduction in seizure frequency and included seizure freedom. Results: Forty patients were included in the study. All patients presented partial epilepsy: 23 symptomatic, 13 cryptogenic, and 4 idiopathic. Reasons for adding LCM were either lack of efficacy (n=37) or intolerable side effects of previous AED regimen (n=3). Patients were taking a mean of 1,7 concomitant AEDs (range 0-4) prior to introduction of LCM. More than half of the patients (62%) had previously tried three or more AEDs. At month 6, 21 of 35 patients (60%) were responders, 9 of which (25%) were seizure-free. Mean daily dose of LCM in this group was 290 mg (range 100-400 mg). At month 12, 21 of 31 patients (67.7%) were responders, 6 of which (19%) were seizure-free. Mean daily dose of LCM in this group was 356 mg (range 100-600 mg). Adverse events were recorded in 12 patients (30%) and leaded to withdrawal of LCM in 3 (7.5%). Conclusions: In this retrospective study LCM was well tolerated and showed high and sustained efficacy in epilepsies with exclusively or almost exclusively nocturnal seizures.