Ventricular tachycardia associated with lacosamide co-medication in drug-resistant epilepsy

Abstract

We report a case of sustained ventricular tachycardia following the initiation of lacosamide as adjunctive epilepsy treatment. A 49-year-old male with intractable frontal lobe seizures experienced severe ventricular tachycardia following the addition of 400 mg lacosamide to his existing regimen of carbamazepine, lamotrigine, clonazepam, and valproate. The tachycardia occurred during a cardiac stress test; stress tests prior to initiation of lacosamide were normal. Conduction defects, including QRS prolongation, persisted during hospitalization until lacosamide was discontinued. The patient had no prior history of cardiac arrhythmia but did possess cardiac risk factors, including hypertension, hypercholesterolemia, and low heart rate variability. This case represents one part of a growing body of literature suggesting a link between arrhythmia and use of lacosamide, which enhances slow inactivation of sodium channels in both the brain and the heart. We believe further study may be necessary to assess the safety of lacosamide in epilepsy patients with cardiac risk factors.

Lacosamide cardiac safety: clinical trials in patients with partial-onset seizures

“…These have included individual case reports of bradycardia (24); second-degree AV block (Mobitz Type I) (25); ventricular tachycardia (26); sinus node dysfunction (27); and atrial flutter/fibrillation (28,29). Each of these six reports involved a patient with POS.…”

A long-term noninterventional safety study of adjunctive lacosamide therapy in patients with epilepsy and uncontrolled partial-onset seizures

“…Several case reports have described cardiac conduction abnormalities in patients with epilepsy receiving lacosamide therapy. Four cases were in patients taking lacosamide as recommended under the current local marketing authorization for the treatment of POS: one experienced bradycardia and second-degree AV block [21], one experienced bradycardia [9], one experienced ventricular tachycardia during a cardiac stress test [22], while the other experienced atrial fibrillation [23]. Two additional cases were in patients with POS taking lacosamide at a higher than approved dosage: one experienced atrial flutter/fibrillation (600 mg/day) [24], while the other experienced sinus node dysfunction (500 mg/day) [25].…”

“…A small dose-related increase in the PR interval has been observed in trials of oral and intravenous lacosamide, with no significant change in blood pressure or QTc interval [11][12][13][18][19][20]. There have also been some published reports of cardiac AEs in patients receiving lacosamide [9,18,[21][22][23][24][25][26][27][28].…”

The efficacy of lacosamide as monotherapy and adjunctive therapy in focal epilepsy and its use in status epilepticus: clinical trial evidence and experience

“…For details on common AEs, please refer to Table 4. Several case reports have documented life-threatening AEs, such as higher-degree AV blockage, atrial flutter/fibrillation and sinus node dysfunction [Degiorgio, 2010;Nizam et al 2011;Chatzistefanidis et al 2013;Chinnasami et al 2013;Degiorgio et al 2013]. Another case report showed reversible suicidal ideation after several months of exposure to 400 mg/day LCM in a 47-year-old man suffering from partial epilepsy since adolescence [Kellinghaus, 2013].…”