Long-term lacosamide retention-Real-world experience at a tertiary epilepsy center in Ireland

•100 adults prescribed lacosamide for seizure control (15 as monotherapy)•Real-world cohort at a tertiary epilepsy center with a mix of types of epilepsy•High prevalence of intellectual disability, medical, and mental health comorbidities•Lacosamide retention at 12 and 24 months was 76% and 71%, respectively•The most common reason for lacosamide withdrawal was ineffective seizure control

PurposeTo estimate the rate of long-term lacosamide retention among a real-world group of patients at a tertiary epilepsy center in Ireland.MethodsOne-hundred adults first prescribed lacosamide for epilepsy between January 2010 and August 2014 at Cork University Hospital were randomly selected for a retrospective analysis of medical records covering two years of subsequent epilepsy clinic follow-up to ascertain whether lacosamide was continued or withdrawn.ResultsOf 100 patients, (51 males, mean age 40.8 years, 94 with drug-resistant epilepsy, 76 with focal epilepsy, 25 with intellectual disabilities, 34 with mental health disorders, and 42 with medical comorbidities), lacosamide was prescribed as an adjunct in 85. Lacosamide retention at 12 and 24 months was 76% and 71%, respectively. Twenty-five patients stopped lacosamide due to ineffective seizure control. Adverse-effects were responsible for lacosamide discontinuation in three patients and one patient stopped lacosamide pre-pregnancy.ConclusionThe relatively high retention rate at two years suggests that lacosamide is generally well tolerated among people with a range of different epilepsy subtypes, intellectual disabilities, medical comorbidities, and mental health disorders, and can aid seizure control in adult patients with a range of difficult-to-treat epilepsies.