Abstracts

Rationale: Lacosamide (LCM) is an efficacious antiepileptic drug (AED) when treating patients with partial onset seizures. The key issue when using LCM is the down titration of concomitant fast acting sodium channel blockers to minimize the side-effects such as dizziness and blurred vision. Sometimes rapid change of AED treatment is needed either due to adverse events or high seizure frequency. LCM is well tolerated when used in i.v. formulation. Can the same result be archived when using oral loading dose?Methods: So far eight patients with partial onset seizure have been treated in the following way: initially 200 mg LCM given at bed time and the next day continuing on 100 mg LCM bid, thereafter increase in dose with 50 mg LCM every 5th day. Simultaneously begin down tapering of concomitant fast acting sodium channel blockers. Target dose fo LCM was 200 mg bidResults: Four males and four females age 28-55 years, mean 40,6 years participated. Duration of epilepsy was 4-54 years, mean 18 years. Four of the patients were in the epilepsy surgery program. Two patients were changes in medication due to side effects of earlier AEDs and one of these was seizure free. Concomitant AEDs 0-3, mean 1,3 and earlier number of AEDs 3-10, mean 5,3. All were initially treated as in-patients, some only for a few days. All eight patients followed the planned schedule for introduction of LCM and in none of the patients were the side effects more pronounced than seen when using the traditional slow up titration. Despite the down titration of concomitant fast acting sodium channel blockers the seizure control was not lost in any of the patients. On the contrary there was better seizure control in all patients after adding LCM.Conclusions: Oral loading dose of LCM was surprisingly well tolerated even in more fragile patients, the key issue here as when starting with the usual slow titration schedule is to plan the down titration of the fast acting sodium blockers to minimize/avoid side effects. With more experience with oral loading of LCM this can also in selected patients be used in outpatients and shorted the time to steady state.