Lacosamide use in the treatment of refractory epilepsy in tuberous sclerosis complex

• Forty-eight percent of TSC patients with refractory epilepsy (n = 46) were responders.
• There were no differences between responders and non-responders.
• Retention rate for LCS in patients with TSC was high (>60% after 5 years).
• Thirty-one patients tolerated LCS well (67%), with no adverse reactions.
• Side effects seen in this cohort were common to LCS use in the general population.

Lacosamide (LCS) was approved by the United States Food and Drug Administration (FDA) in 2008 as adjunctive therapy to other anti-epileptic drugs (AEDs) to treat focal-onset seizures, with or without secondary generalization. Its role in the treatment of epilepsy in individuals with tuberous sclerosis complex (TSC) has yet to be determined. This study evaluates LCS treatment of focal-onset refractory epilepsy in patients with TSC. From November 2009 to June 2014, 46 TSC patients followed by a single neurologist were treated with LCS. Forty-eight percent were responders (seizure reduction ≥50%). No significant differences between responders and non-responders in demographic characteristics were found. LCS appears to be an effective and safe treatment of refractory focal onset seizures in TSC. Determining the long-term tolerability and efficacy of LCS in TSC patients requires additional clinical experience.