Epilepsy Information

American Academy of Neurology (P06.115)

Adjunctive Therapy with Lacosamide for Older Epilepsy Patients

Authors: Evan Fertig, Melissa Fleming, Enrique Feoli, Georges Ghacibeh, Olgica Laban, Cristos Lambrakis, Salah Mesad, Jeffrey Politsky and Marcelo Lancman

To examine the outcome of adjunctive therapy with lacosamide (LCS) in older epilepsy patients.

As only 18 elderly patients were enrolled in the LCS partial-onset clinical trials, the effectiveness for this cohort is relatively unknown. Also, the pharmacokinetics differ (20% higher AUC and Cmax values are observed in healthy elderly vs. younger controls), but the clinical significance has not been determined. LCS can rarely induce conduction abnormalities (asymptomatic 1st degree AV block in epilepsy trials and atrial fibrillation/flutter in diabetic neuropathy trials). Older patients with these comorbidities may be at higher risk.

A retrospective chart review identified patients > 50 yo on LCS. Relevant clinical factors were collected for those with documented pre-treatment and post-treatment seizure frequencies. Total mean seizure frequency 3 mo before initiation and at last follow-up were calculated, and the 50% responder rates were determined. Reason for discontinuation was classified as due to ineffectiveness or AE.

Thirty subjects with mean seizure onset/LCS start of 30.79 yrs (0-82) and 61.3 yrs (50-84) were included. Epilepsy syndrome was partial for all but one. Twenty-seven had failed > 2 past AED trials. Two had coronary artery disease and one diabetes. In the last 3 treatment months, 18 (60%) had > 50% total seizure reduction and 9 (30%) were seizure-free. Mean treatment duration/mean dose was 12.8 mo and 219 mg. Fourteen (47%) had AE's: CNS-related were most common (dizziness/sedation). Seven (23%) withdrew: 4 (13%) due to AE's (none cardiac-related).

LCS was effective in this sample and comparable to previous studies. Although CNS-related AE's were common, the rate of withdrawal due to AE's was no higher than previous studies. No cardiac AE's occurred. Combination with a sodium channel blocker (SCB) or LEV was not associated with treatment outcome as previously seen. Additional study in a larger sample is warranted.

Dr. Fertig has nothing to disclose. Dr. Fleming has nothing to disclose. Dr. Feoli has nothing to disclose. Dr. Ghacibeh has received personal compensation for activities with UCB Pharma as a speaker. Dr. Laban has received personal compensation for activities with UCB Pharmaceuticals as a speaker. Dr. Lambrakis has nothing to disclose. Dr. Mesad has nothing to disclose. Dr. Politsky has received personal compensation for activities with UCB, Novartis, GlaxoSmithKline, Ortho-McNeill, and Eisai as a speaker and consultant.Dr. Politsky has received research support from UCB Pharmaceuticals, Cyberonics, Glaxo-Smith-Kline, and Neuropace Inc. Dr. Lancman has received research support from UCB Pharmaceuticals.