Successful treatment with adjunctive lacosamide in a patient with long term “drug resistant” focal epilepsy

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Journal of Epileptology

Foundation of Epileptology

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VOLUME 22 , ISSUE 1 (June 2014) > List of articles

Successful treatment with adjunctive lacosamide in a patient with long term “drug resistant” focal epilepsy

Walter Fröscher * / Alois Rauber

Keywords : epilepsy, drug resistance, lacosamide

Citation Information : Journal of Epileptology. Volume 22, Issue 1, Pages 51-55, DOI: https://doi.org/10.1515/joepi-2015-0014

License : (CC BY 4.0)

Received Date : 11-February-2014 / Accepted: 05-March-2014 / Published Online: 11-March-2014

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ABSTRACT

Introduction. A significant number of patients suffering from epilepsy prove to be resistant to antiepileptic drugs (AEDs). Recent studies, however, suggest that 10–20% of seemingly drug resistant patients may still become seizure-free under the influence of subsequent dosage modifications.

Case report. We report on a young man with cryptogenic focal epilepsy. He had his first seizure at the age of fifteen. His seizure frequency was decreased during the following 11 years. However, seizure-freedom was never achieved even though he was treated with twelve to fourteen different AEDs during this time. Intensive presurgical evaluations did not allow identification of a surgically remediable focus. Adjunctive treatment with lacosamide 400 mg/day was not successful. However, the patient became seizure-free immediately after an increase of the lacosamide dose up to 500 mg/day. The patient is now seizure-free for more than two years based on a combination of 500 mg lacosamide and 350 mg lamotrigine, followed by 550 mg and 250 mg, respectively.

Discussion and conclusion. This case report highlights that there is always a chance that modifying the medication can result in a drug-resistant epilepsy patient experiencing a significant reduction of seizures and becoming seizure-free. The decisive step in this example was the off-label prescription of a high dose of lacosamide which the patient tolerated well.

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REFERENCES

Ben-Menachem E.: Medical management of refractory epilepsy – Practical treatment with novel antiepileptic drugs. Epilepsia, 2014, 55, Suppl 1: 3–8.

 

Callaghan B.C., Anand K., Hesdorffer D., Hauser W.A., French J.A.: Likelihood of seizure remission in an adult population with refractory epilepsy. Ann. Neurol., 2007, 62: 382–389.

 

Chung S.: Lacosamide: new adjunctive treatment option for partial-onset seizures. Expert. Opin. Pharmacother., 2010, 11: 1559–1602.

 

Chung S., Ben-Menachem E., Sperling M.R., Rosenfeld W., Fountain N.B., Benbadis S. et al.: Examining the clinical utility of lacosamide: Pooled analyses of three phase II/III clinical trials. CNS Drugs, 2010a, 24: 1041–1054.

 

Chung S., Sperling M.R., Biton V., Krauss G., Hebert D., Rudd G.D. et al.: Lacosamide as adjunctive therapy for partial- onset seizures: A randomized controlled trial. Epilepsia, 2010b, 51: 958–967.

 

Contin M., Albani F., Riva R., Candela C., Mohamed S., Baruzzi A.: Lacosamide therapeutic monitoring in patients with epilepsy: Effect of concomitant antiepileptic drugs. Ther. Drug Monit., 2013, 35: 849–852.

 

Fröscher W.: Drug resistant epilepsy. Epileptologia, 2012, 20: 17–23.

 

Fröscher W., Auner M., Kirschbaum J.: Behandlungsergebnisse bei pharmakoresistent erscheinenden Patienten (Therapeutic results in apparent drug-refractory epileptics). Akt. Neurol., 1989, 16: 1–8.

 

Fröscher W., Rösche J.: Kombinationstherapie bei Epilepsie (Combination therapy for epilepsy). Fortschr. Neurol. Psychiat., 2013, 80: 9–20.

 

Greenaway C., Ratnaraj N., Sander J.W., Patsalos P.N.: A high-performance liquid chromatography assay to monitor the new antiepileptic drug lacosamide in patients with epilepsy. Ther. Drug Monit., 2010, 32: 448–452.

 

Hoy S.M.: Lacosamide: A review of its use as adjunctive therapy in the management of partial-onset seizures. CNS Drugs, 2013, 27: 1125–1142.

 

Kwan P., Arzimanoglou A., Berg A.T., Brodie M.J., Hauser W.A., Mathern G. et al.: Definition of drug resistant epilepsy: Consensus proposal by the ad hoc task force of the ILAE commission on therapeutic strategies. Epilepsia, 2010, 51: 1069–1077.

 

Kwan P., Schachter St.C., Brodie M.J.: Drug resistant epilepsy. N. Engl. J. Med., 2011, 365: 919–926.

 

Luciano A.L., Shorvon S.D.: Results of treatment changes in patients with apparently drug-resistant chronic epilepsy. Ann. Neurol., 2007, 62: 375–381

 

Mula M.,Godi L., Onorato S., Savoini G.: Successful treatment of super-refractory status epilepticus with intravenous lacosamide. Epileptologia, 2012, 20: 81–85.

 

Munger Clary H., Choi H.: Prognosis of intractable epilepsy: Is long-term seizure freedom possible with medical management? Clin. Neurol. Neurosci. Rep., 2011, 11: 409–417.

 

Neligan A., Bell G.S., Sander J.W., Shorvon S.D.: How refractory is refractory epilepsy? Patterns of relapse and remission in people with refractory epilepsy. Epilepsy Res., 2011, 96: 225–230.

 

Patsalos P.N.: Drug interactions with the newer antiepileptic drugs (AEDs) – Part 1. Pharmacokinetic and pharmacodynamic interactions between AEDs. Clin. Pharmacokinet., 2013, 52: 927–966.

 

Pedersen B., Rasmussen J.B.: Lacosamide treatment – added value of plasma levels? Epilepsia, 2013, 54, Suppl 3: 171.

 

Sattler A., Schaefer M., May T.W., Rambeck B., Brandt C.: Fluctuation of lacosamide serum concentrations during the day and occurrence of drug reactions – first clinical experience. Epilepsy Res., 2011, 95: 207–212.

 

Schiller Y., Najjar Y.: Quantifying the response to antiepileptic drugs: effect of past treatment history. Neurology, 2008, 70: 54–65.

 

Vimpat® product information (Fachinformation). UCB Pharma GmbH, Monheim, Germany. 31.7.2013.

 

Wittstock M., Benecke R., Rösche J.: Transient third-degree atrioventricular block following rapid lacosamide titration in a patient with nonconvulsive status epilepticus. Epileptologia, 2011, 19: 165–169.

 

Zaccara G., Perucca P., Loiacono G., Giovanelli F., Verrotti A.: The adverse event profile of lacosamide: a systematic review and meta-analysis of randomized controlled trials. Epilepsia, 2013, 54: 66–74.

 

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