title: Adjunctive lacosamide--5 years' clinical experience.
abstract: OBJECTIVE
  In 2008, lacosamide (LCM) was licensed in Europe for the adjunctive treatment of focal-onset seizures. At that time a prospective audit was initiated at the Western Infirmary to assess outcomes with this antiepileptic drug (AED) in everyday clinical practice.
  
  
  METHODS
  A total of 160 patients (74 M; 86 F, aged 14-74 years [median 42 years]) with uncontrolled focal-onset seizures (median monthly frequency 1; range 1-300) were started on LCM. After 12 weeks on stable AED doses (median 1 AED; range 1-4), LCM was added and the dose titrated as appropriate with a target range of 200-400 mg/day. Review took place every 6-8 weeks until 1 of 4 end-points was reached: seizure freedom for 6 months on a given LCM dose; ≥50% (responder) or <50% (marginal benefit) seizure reduction over 6 months compared with baseline on the highest tolerated LCM dose; withdrawal of LCM due to lack of efficacy, side effects, or both.
  
  
  RESULTS
  Of the 160 patients, 35 (21.9%) remained seizure-free for at least 6 months on a stable LCM dose, while 35 (21.9%) had a ≥50% reduction in seizure frequency and 54 (33.7%) reported a marginal benefit. Five patients became seizure-free on LCM monotherapy following withdrawal of their initial treatment. Outcomes were similar for patients taking LCM with traditional sodium blocking agents (n=56; 43 [76%] continued LCM) compared to those who also received AEDs with other mechanisms (n=84; 64 [76%] continued LCM). LCM was discontinued in 36 (22.5%) patients because of lack of efficacy (n=24, 15%) or side effects (n=12; 7.5%). Commonest side effects leading to withdrawal were nausea and vomiting, dizziness, sedation, headaches, tremor, and ataxia, particularly for patients also taking sodium valproate.
  
  
  CONCLUSIONS
  LCM is a well-tolerated and effective AED for focal-onset seizures with or without secondary generalisation, regardless of concomitant treatment. Commonest dose-related side effects were neurotoxic in nature.
authors: Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK. Electronic address: linda.stephen@ggc.scot.nhs.uk.
authors: Linda J
authors: LJ
authors: Stephen
authors: Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK.
authors: Kevin
authors: K
authors: Kelly
authors: Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK.
authors: Pamela
authors: P
authors: Parker
authors: Epilepsy Unit, Division of Cardiovascular and Medical Sciences, Western Infirmary, Glasgow, Scotland, UK.
authors: Martin J
authors: MJ
authors: Brodie
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000078334:Lacosamide; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide
keywords: Adjunctive; Epilepsy; Focal; Lacosamide; Outcomes; Seizures