A Clinical-EEG Study of Sleepiness and Psychological Symptoms in Pharmacoresistant Epilepsy Patients Treated with Lacosamide

Abstract

Our aim was to evaluate the EEG and clinical modifications induced by the new antiepileptic drug lacosamide (LCM) in patients with epilepsy. We evaluated 10 patients affected by focal pharmacoresistant epilepsy in which LCM (mean 250 mg/day) was added to the preexisting antiepileptic therapy, which was left unmodified. Morning waking EEG recording was performed before (t0) and at 6 months (t1) after starting LCM. At t0 and t1, patients were also administered questionnaires evaluating mood, anxiety, sleep, sleepiness, and fatigue (Beck Depression Inventory; State-Trait Anxiety Inventory Y1 and Y2; Pittsburgh Sleep Quality Index; Epworth Sleepiness Scale; Fatigue Severity Scale). We performed a quantitative analysis of EEG interictal abnormalities and background EEG power spectrum analysis. LCM as an add-on did not significantly affect anxiety, depression, sleepiness, sleep quality, and fatigue scales. Similarly, adding LCM to preexisting therapy did not modify significantly patient EEGs in terms of absolute power, relative power, mean frequency, and interictal abnormalities occurrence. In conclusion, in this small cohort of patients, we confirmed that LCM as an add-on does not affect subjective parameters which play a role, among others, in therapy tolerability, and our clinical impression was further supported by evaluation of EEG spectral analysis.

Assessment of the effects of lacosamide on sleep parameters in healthy subjects

“…40 These data suggest that our observations may extend to subjective assessments of sleep in patients with epilepsy. Further study in patients with different types of epilepsy should be conducted to assess whether lacosamide has any impact on objective or subjective sleep parameters, including arousals, stage Table 2 Summary of changes in sleep parameters in healthy subjects before and after treatment with lacosamide 300 mg/day (N = 25, full analysis set was reported for 1 subject; however, no protocol-defined seriousness criteria were met.…”

Lacosamide modulates interictal spiking and high-frequency oscillations in a model of mesial temporal lobe epilepsy

“…To date, no study has specifically explored the effect of LCM on interictal spikes in patients with MTLE. However, in patients with pharmacoresistant focal epilepsy, Li et al (2013) found a nonsignificant reduction of interictal epileptiform activity after acute intravenous LCM treatment, whereas no effect were observed by Giorgi et al (2013) following adjunctive per os treatment with LCM. Moreover, it has been reported in the perforant path stimulation model that LCM induces a decrease in interictal spike rates in the dentate gyrus 6 weeks after SE (Wasterlain et al, 2011).…”

Effects of antiepileptic drugs on interictal epileptiform discharges in focal epilepsies: an update on current evidence

“…In some studies, a tendency toward the reduction of IEDs incidence after acute [49] and chronic administration [50] in small samples of patients with focal epilepsy has been reported, even though the results were not statistically significant and the patient samples were too small to allow clear conclusions.…”