Adjunctive lacosamide in clinical practice: Sodium blockade with a difference?

► Lacosamide is thought to exert its antiepileptic effect by enhancing sodium channel slow inactivation. ► The drug was effective and well tolerated when used with traditional sodium blockers as well as antiepileptic drugs with other mechanisms. ► Seizure freedom was more likely when lacosamide was used as a first add-on than with a later treatment schedule. ► Patients on sodium valproate were more likely to stop lacosamide (most with side effects) than those taking other antiepileptic drugs. ► Results suggest that lacosamide's pharmacological effect differs from that of other antiepileptic drugs that influence sodium channel fast inactivation.