title: Effects of lacosamide and carbamazepine on human motor cortex excitability: a double-blind, placebo-controlled transcranial magnetic stimulation study.
abstract: OBJECTIVE
  Lacosamide (LCM) and carbamazepine (CBZ) are antiepileptic drugs both acting on neuronal voltage-gated sodium channels. Patch-clamp studies demonstrated significant differences in how LCM and CBZ affect neuronal membrane excitability. Despite valuable information patch-clamp studies provide, they also comprise some constraints. For example, little is known about effects of LCM on intracortical synaptic excitability. In contrast, transcranial magnetic stimulation (TMS) can describe drug-induced changes at the system level of the human cerebral cortex.
  
  
  METHODS
  The present study was designed to explore dose-depended effects of LCM and effects of CBZ on motor cortex excitability with TMS in a randomized, double-blind, placebo-controlled crossover trial in healthy human subjects. Subjects received 600 mg CBZ, 200 mg LCM, 400 mg LCM or placebo preceding TMS measurements.
  
  
  RESULTS
  Compared to placebo, TMS motor thresholds were significantly increased after carbamazepine and lacosamide, with a trend for a dose dependent effect of lacosamide. Both, carbamazepine and lacosamide did not affect TMS parameters of intracortical synaptic excitability.
  
  
  CONCLUSIONS
  TMS measurements suggest that lacosamide and carbamazepine predominantly act on neuronal membrane excitability.
authors.affiliation: Department of Neurology, Christian-Albrechts-University, Kiel, Germany. Electronic address: n.lang@neurologie.uni-kiel.de.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lang
authors.forename: Holger
authors.initials: H
authors.lastname: Rothkegel
authors.forename: Hannes
authors.initials: H
authors.lastname: Peckolt
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
mesh_terms: D000081:Acetamides / Q000494:pharmacology* / Q000627:therapeutic use; D000328:Adult; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000494:pharmacology* / Q000627:therapeutic use; D002220:Carbamazepine / Q000494:pharmacology* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004827:Epilepsy / Q000188:drug therapy / Q000473:pathology*; D019054:Evoked Potentials, Motor / Q000187:drug effects*; D005260:Female; D006801:Humans; D000078334:Lacosamide; D008297:Male; D009044:Motor Cortex / Q000187:drug effects*; D050781:Transcranial Magnetic Stimulation; D055815:Young Adult
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D002220:Carbamazepine; D000078334:Lacosamide
keywords: Carbamazepine; Epilepsy; Lacosamide; Motor threshold; Transcranial magnetic stimulation; Voltage-gated sodium channel