title: Lacosamide as adjunctive therapy in refractory epilepsy in adults: a systematic review.
abstract: OBJECTIVE
  To review the evidence for efficacy and safety of lacosamide in adult patients with refractory epilepsy and refractory status epilepticus (RSE).
  
  
  METHODS
  A systematic literature search of MEDLINE, PubMed, EMBASE, IPA, Google and Google Scholar (through October 2014) was performed.
  
  
  RESULTS
  Fourteen studies assessing lacosamide in 3509 refractory epilepsy patients were included. In 3 RCTs, more patients had at least 50% reduction in seizure frequency with lacosamide compared to placebo with 38.3-41.1%, 38.1-41.2%, and 18.3-25.8%, in the 400 mg/day, 600 mg/day, and placebo groups, respectively. In non-comparative trials, 18-69% of patients achieved at least 50% reduction in seizure frequency, and 1.7-26.2% achieved seizure freedom. Non-responders were documented in two trials, with 26.2-34% having no response. Thirteen studies assessing lacosamide in 390 RSE patients were included. When assessing lacosamide's ability to terminate RSE, one comparative cohort study found no improvement in SE duration or seizure control with addition of lacosamide. Another study documented no difference compared to use of phenytoin. Eleven descriptive studies using lacosamide as add-on RSE therapy revealed seizure termination rates of 0-100% (median 64.7%). In all patients receiving lacosamide, dizziness (21.8%), vision disturbances (10.4%), drowsiness (7.4%), headache (7.0%), nausea (6.5%), and coordination problems (5.8%) were the most common adverse effects.
  
  
  CONCLUSIONS
  Based on evidence to date, adjunctive lacosamide is a treatment option to reduce seizure frequency in patients with refractory epilepsy and terminate seizures in patients with RSE. The safety information summary can be used to advise patients of potential adverse effects.
authors: Department of Pharmacy, Children's and Women's Health Center of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4. Electronic address: vpaquette@cw.bc.ca.
authors: Vanessa
authors: V
authors: Paquette
authors: Department of Pharmacy, Royal Jubilee Hospital, 1352 Bay Street, Victoria, British Columbia, Canada V8R 1J8. Electronic address: celia.culley@viha.ca.
authors: Celia
authors: C
authors: Culley
authors: Department of Pharmacy, Victoria General Hospital, 1 Hospital Way, Victoria, British Columbia, Canada V8Z 6R5; Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: erica.otto@viha.ca.
authors: Erica D
authors: ED
authors: Greanya
authors: Department of Pharmacy, Children's and Women's Health Center of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada V6H 3V4; Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 1Z3. Electronic address: ensom@mail.ubc.ca.
authors: Mary H H
authors: MH
authors: Ensom
mesh_terms: D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000078334:Lacosamide; D012640:Seizures / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide
keywords: Anticonvulsant; Antiepileptic drug; Seizure; Status epilepticus