Abstracts

Rationale: The aim of this study was to evaluate the efficacy of Lacosamide (LCM) when added to the concomitant antiepileptic drugs (AEDs) in patients with uncontrolled seizures which enhances the slow inactivation of voltage-gated sodium channels.Methods: Until now LCM was added to one to five concomitant AEDs in 60 patients with uncontrolled seizures. Thirty-one of the patients were male and 29 were female. Sixty epileptic patients with different etiologies (patients with Lennox-Gastaut Syndrome (LGS), Myoclonic Epilepsy with Ragged Red Fibers (MERRF), Dandy -Walker Syndrome, sequelae of cerebral palsy, medullablastoma operation, encephalomalacic area in the left temporal region, cerebral infarction in the left occipital region, liver embryonal sarcoma operation, gliosis in the left temporal lobe, an autism spectrum disorder, frontal cortical-subcortical hyperintense lesions, frontal cortical dysplasia, right frontal cortical-subcortical hyperintense lesion, left hippocampal sclerosis, left medial sclerosis, sequel of meningitis, oligodendroglioma operation, Rett syndrome, poststroke epilepsy, posttraumatic epilepsy and idiopathic generalised epilepsy) were included in this report. The seizure types of the patients were partial and primarily generalised in 4.. Two of the 60 patients received 5, 10 received 4, 23 received 3, 16 received 2 AEDs and 4 received monotherapy. After starting LCM, 2 patients stopped taking the drug because of some adverse effects, 3 stopped because they did not want to take the drug any more. Carbamazepine, clobazam, oxcarbazepine, lamotrigine, levetiracetam, phenobarbital, pregabalin, topiramate, valpropate and zonisamide were the drugs which were used as polytherapy in different combinations for each patient. The seizure frequency and severity were evaluated according to the diaries and the history of the patients. LCM was given twice 100-400 mg/day.Results: The mean age of the patients were 36.9 (18-66). LCM therapy was given between January 2013 - May 2015. A >50% reduction in seizure frequency was achieved in 16 patients (37.5%). A 50% reduction in seizure frequency was observed 6 patients (10%) and <50% in 10 (6%) patients .Five of the patients did not respond to the therapy. LCM was started in 5 patients recently. Three of the patients reported some dizziness, 1 reported loss of vision and diplopia, 1 headache, 1 rash, and 1 reported some changes in menstruel frequency cycle as adverse effects.Conclusions: LCM is a novel antiepileptic agent. The pharmacokinetic profile of LCM includes a fast rate of absorption, dose-proportional plasma concentrations across the approved dose range, minimal cytochrome P450 interaction, and low (<15%) protein binding. In addition to partial-onset seizures in patients with epilepsy 4 of our patients with idiopathic generalised epilepsy responded well to add-on therapy with LCM. We believe that LCM will not only be a drug of choice for partial-onset seizures but for idiopathic generalised seizures as well in the future.