Lacosamide as adjunctive therapy in refractory epilepsy in adults: A systematic review

• Reviewed 3509 patients with refractory epilepsy (RE) from 14 studies.
• Reviewed 390 patients with refractory status epilepticus (RSE) from 13 studies.
• Lacosamide reduced seizure frequency by at least 50% in up to 69% of patients with RE.
• Lacosamide terminated seizures in up to 100% of patients with RSE.
• The most frequently reported adverse event of lacosamide was dizziness.

PurposeTo review the evidence for efficacy and safety of lacosamide in adult patients with refractory epilepsy and refractory status epilepticus (RSE).MethodsA systematic literature search of MEDLINE, PubMed, EMBASE, IPA, Google and Google Scholar (through October 2014) was performed.ResultsFourteen 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.ConclusionBased 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.