Cognitive effects of lacosamide as adjunctive therapy in refractory epilepsy

Abstract

Background Lacosamide (LCM) is a novel antiepileptic drug (AED) with potential benefit as adjunctive treatment in patients with partial‐onset seizures. As yet, limited information on cognitive effects of LCM is available, especially in real‐life settings. Aims In this open clinical prospective study, the cognitive effects of LCM were evaluated when used as adjunctive antiepileptic therapy in patients with refractory epilepsy. Methods We included 33 patients aged between 16 and 74 years (mean: 37 years). All patients had a localization‐related epilepsy. Patients were assessed at baseline before starting LCM treatment and during follow‐up when the optimal clinical dose was achieved. Materials Subjective complaints were evaluated using the SIDAED; effects on cognition were evaluated using the computerized visual searching task (CVST). Results The CVST showed significant faster information processing reaction times at the second evaluation (P = 0.013), which was not correlated with seizure control, type of epilepsy, age, gender, drug load, number of concomitant drugs, dose or duration of LCM treatment. On the SIDAED, patients complained more about their cognitive function at the second evaluation (P = 0.005). For the SIDAED, a positive correlation at follow‐up was found between the total severity score and higher age (r = 0.375, P = 0.031), but not with epilepsy factors or treatment characteristics. Discussion/Conlusion Screening of the cognitive effects of LCM showed that LCM does not have negative effects on information processing speed. As this is the most sensitive function for cognitive side effects of AEDs, LCM does not seem to induce the common negative cognitive effects. Remarkably, patients complained more, especially about their cognitive function, which is possible the ‘doing better, feeling worse phenomenon’.

Lacosamide and sodium channel-blocking antiepileptic drug cross-titration against levetiracetam background therapy

“…Overall, TEAEs reported during this trial were consistent with the known safety profile of LCM,25 and no new safety signals were detected. Recent data also indicate that adjunctive LCM does not affect information processing speed, the most sensitive function for cognitive side effect of AEDs, confirming observations in healthy volunteers 26, 27 …”

The effects of lacosamide on cognition, quality-of-life measures, and quality of life in patients with refractory partial epilepsy

“…Our results are consistent with previous studies. IJff et al [7] examined 33 patients with refractory partial epilepsy in which lacosamide was added to their previous AED regimen. Two psychometric tools were used: the SIDAED and the Computerized Visual Searching Task (CVST).…”

“…Other data regarding mood/cognition have been limited to small prospective uncontrolled or retrospective studies. IJff et al [7] studied patients with refractory partial-onset epilepsy prospectively before and after lacosamide was added as adjunctive therapy. The authors reported that patients had increased subjective complaints but that, objectively, they did not do worse with lacosamide on a computerized task [7].…”

“…IJff et al [7] studied patients with refractory partial-onset epilepsy prospectively before and after lacosamide was added as adjunctive therapy. The authors reported that patients had increased subjective complaints but that, objectively, they did not do worse with lacosamide on a computerized task [7]. Helmstaedter and Witt retrospectively studied the impact of adjunctive lacosamide and compared it with that of topiramate and lamotrigine in a naturalistic outpatient setting and concluded that cognitive effects were equivalent to lamotrigine and better than topiramate [8].…”

Lacosamide in bipolar disorder: A 30‐day comparison to a retrospective control group treated with other antiepileptics

“…Lacosamide was shown to reduce cocaine‐induced elevations in reward function in rats, which is considered to be a common feature of manic episodes . It has also showed a more beneficial psychotropic profile than other antiepileptic drugs, especially regarding affective symptoms, and caused no impairment of cognitive abilities . However, its off‐label use is still limited.…”