Abstracts

Rationale: Nocturnal frontal lobe epilepsy (NFLE) is a partial epilepsy syndrome for which sodium-channel mediating antiepileptic medications, particularly carbamazepine, are proven highly effective therapy for up to 70% of patients. Still, a substantial portion of NFLE patients fail to respond or have adverse events with standard medications and might benefit from alternative agents. The objective of this report is to evaluate the potential value of a newer and different sodium-channel mediating agent, lacosamide, for treatment-resistant NFLE. Methods: We performed a retrospective analysis of all patients with NFLE seen at the University of Maryland Epilepsy Center from 2008 to 2011, the time period during which lacosamide has been available. Patient response to treatment was assessed, and those who were treatment-resistant or had adverse effects from medications were offered alternatives, which included lacosamide. Among these patients given lacosamide, responses were evaluated.Results: We identified 16 patients diagnosed with NFLE. Of those patients, 7 (44%) reported doing well and were satisfied with their seizure control and lack of adverse effects. For the remaining 9 patients, alternative medications or adjustments to therapy were offered. Four patients were specifically offered a trial of lacosamide and 2 chose to add it on as adjuvant therapy. The dose of lacosamide ranged from 200-600 mg total daily, and patients were followed for over 1 year. Both patients reported improved seizure control and tolerability. In one patient the improvement in seizure frequency was immediate, persisted for over one year, and was reestablished with an increase in dosage. For the other patient, lacosamide was better tolerated after discontinuation of the concomitant antiepileptic medication. Currently, both patients report satisfaction with seizure control, with one patient seizure-free and the other experiencing rare, mild episodes when sleep-deprived. Conclusions: A substantial portion of patients diagnosed with NFLE and treated with standard medication report unsatisfactory seizure control or adverse effects warranting consideration of alternative treatments. Based on our preliminary experience, lacosamide, a new sodium-channel mediating agent, should be considered in future clinical trials as an alternative treatment for patients with NFLE who fail standard therapy.