Abstracts

Rationale: Lacosamide (LCM) is an antiepileptic drug approved by FDA in 2008 as adjunctive treatment for focal refractory epilepsies. It enlaces the slow-inactivation of voltage-gated sodium channels. Efficacy has been proven in addition with non-sodium channel blockers and also with other sodium channel blockers though adverse events are higher in this second group. Efficacy and safety have been analyzed after 12 months of LCM treatment in our patients. Methods: Observational, retrospective multicenter study performed in 9 secondary and tertiary hospitals in Galicia (Spain) analyzing demographic, clinical and pharmacological data of 184 patients after 3, 6 and 12 months of lacosamide use as adjuntive treatment in focal epilepsies. Concomitant number and dosage of AEDs before and after LCM usage were also determined. Statistical analysis was performed with SPSS version 19.0. A p < 0.05 value was considered significant. Response to LCM was achieved if a diminution of ³ 50% of seizures was reported. Results: Data from 184 patients that started LCM treatment and completed 12 months of treatment was analyzed. Mean age was 44.2±17.4 years old with a mean time of evolution of epilepsy of 18.8±15.5 years old. 56.5% were males. 48.9% of the epilepsies were located in the temporal lobe. According to etiology, 33.9% were cryptogenic. Previous to LCM 42.1% of patients were receiving treatment with 2 AEDs and 28.4% with one. Median number of seizures at baseline was 2.5 [1, 6] per month. After 12 months, 31.2% of patients remained seizure-free and 68.2% were responders. 23.4% presented with adverse events at 12 months being dizziness (10.3%) and instability (3.3%) the most frequently observed. Treatment was stopped in because of adverse effects 10 patients (5.4%), due to inefficacy in 6 (3.3%) and for other reasons in 7 patients (3.8%). Median dose of LCM was 300 [100, 500] mg/dl. In 21.3% of patients, LCM was the first sodium-channel blocker administered. With LCM, number of concomitant AEDs has been significantly reduced (from 2.1±1 to 1.8±0.9; p< 0.001). Dosage of concomitant AEDs was also significantly diminished in particular those sharing mechanism of action with LCM (sodium channel blockers). Conclusions: Lacosamide offers a safety profile and efficacy in patients with refractory epilepsy. High percentage of responders may be due to a less refractory population. LCM offers a good balance between efficacy and safety in these patients thus it can be considered as an early adjunctive treatment option for focal epilepsies.