Abstracts

Rationale: Lacosamide was FDA approved in 2008 for partial onset seizures. Few studies evaluated its effectiveness in the elderly. This multi-center study documented the use of lacosamide for patients ≥ 60 years in a naturalistic setting. We evaluated the efficacy, safety, tolerability and dosing requirement in this population.Methods: Patients with a diagnosis of epilepsy, ≥ 60 years of age and started lacosamide between October 2008 to December 2014, were identified at the study sites. Patients’ medical history, treatment efficacy and safety measures were retrospectively reviewed. Primary outcome measure was retention rates at 3, 6 and 12 months. Secondary outcome measures were seizure freedom and 50% seizure reduction at final maintenance dose, final effective total daily dose, and days to achieve effective dose.Results: Fifty-two patients were evaluated: 18 were between 60 to 64 years, 16 were between 65 to 69 years, and 18 were 70 years or older. The average time since diagnosis was 24.7 years (SD 23.5). The main seizure type was complex partial seizure (78.8%). Forty-four percent of patients were using lacosamide as monotherapy. Overall 3, 6 and 12-month retention rates were 94.2%, 84.6% and 51.9% respectively. Seizure freedom was achieved in 28.8% of patients. Median maintenance total daily dose was 300mg/day (range 100-600mg/day) in those 60-64 years and 65-69 years; 200mg/day (range 50-400mg/day) in those ≥70years. Average time to maintenance dose was 207 days for those 60-64 years, 195 days for those 65-69 years and 89 days for those ≥70years. During titration phase, 55.6% of those ≥70years, 62.5% of the 65-69 years, and 22.2% of the 60-64 years experienced neurological side effects. The most common neurological adverse effects were dizziness and balance issues.Conclusions: Lacosamide was effective and well-tolerated in our elderly population. Our findings suggest that this population may require a lower dose and an extended titration schedule.