Abstracts

Rationale: (Author's Note: Authors Li and Schmitt contributed equally to this abstract.) Since 2008 lacosamide (LCM) is approved as adjunctive therapy for epielpsy with partial-onset seizures with or without secondary generalization. LCM is available in both oral and intravenous formulations. The bioavailability of oral administration of LCM tablet is approximately 100% and a change of administration route has been shown safe (Krauss G, et al. in Epilepsia. 2010 Jun;51(6):951-7). Dizziness, nausea, headache, and diplopia are the most common side effects of LCM treatment. In the setting of a presurgical video-EEG-monitoring a rapid administration of an antiepileptic drug (AED), which is new for the individual patient, can be advantageous. Methods: The principle purpose of this study is to evaluate the short-term tolerability of intravenous administration of LCM. The second aim is to test the middle-term safety and efficacy of LCM in patients with pharmacoresistant partial epilepsy. 14 patients (7 males and 7 females) with pharmacoresistant epilepsy were admitted at our hospital for presurgical video-EEG-monitoring. After tapering-off the original medication, the patients received de novo intravenous LCM (200mg, twice daily for three days), followed by oral LCM with the same regime. Follow-up visits were conducted after one and three months after discharge from hospital.Results: Two (2/14) patients experienced transient side effects (diplopia and dizziness) during the infusion, and recovered before the oral administration. At the first follow-up two patients reported side effects (dizziness and diplopia), one of them was withdrawn from LCM and the other recovered after a dose reduction of lamotrigine. At the second follow-up three patients complained about side effects (dizziness, tiredness, and diplopia). One patient had to discontinue LCM, one patient was free of side effects after dose reduction of lamotrigine and the third patient recovered after dose reduction of LCM. Nine patients (9/14) were using a traditional sodium channel blocking AED as part of their concomitant regimen, among which two patients were withdrawn from LCM due to severe side effects. In the three month follow up period, significant reduction of seizure frequency (?50% reduction from baseline) was achieved in half of the patients treated. Conclusions: The intravenous administration of LCM is safe and well tolerated in our cohort and the tolerability was similar to oral administration in the three month follow up period. LCM seems to be a suitable option for rapid and de novo administration, for example in the setting of a presurgical video-EEG-monitoring.