Abstracts

Rationale: The current practice for patients with new onset epilepsy who do not achieve seizure freedom on low dose first-line monotherapy antiepileptic drug (AED) is for it to be given at increasingly higher doses until seizure control is achieved, upper end of therapeutic serum level is reached, or there are intolerable side effects. In instances where the first-line AED shows possible synergistic effects with a second AED, addition of a low dose second AED may be preferable to high dose monotherapy. The primary objective of this open label trial is to test the hypothesis that in patients with breakthrough seizures on a low dose of levetiracetam (LEV), the addition of a low dose adjunctive lacosamide (LCM) is more efficacious in achieving seizure freedom over six months as compared to high dose LEV monotherapy. Secondary objectives include six month retention, time to seizure after intervention, and side effect profile. Methods: We conducted a prospective cohort study of adult epilepsy patients who experienced breakthrough seizures on low dose (<