Lacosamide as adjunctive therapy in refractory epilepsy in adults: A systematic review

Paquette, Vanessa; Culley, Celia; Greanya, Erica D.; Ensom, Mary H H

doi:10.1016/j.seizure.2014.11.007

Cited by 29 publications

(18 citation statements)

References 40 publications

(233 reference statements)

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“…Responder rates on BRV were comparable to post-marketing experiences with other recently introduced AEDs such as Perampanel (PER; ≥50% responder rate in the largest three trials: 27–50%) or Lacosamide (LCM; ≥50% responder rate: 18–69%). The same did also apply to rates of seizure-free patients (PER: 14–17% in the largest three trials; LCM: 3–33%), as in the present study, 29% were seizure-free with 8.8% being newly seizure-free ( 23 , 24 ).…”

Section: Discussionsupporting

confidence: 52%

Brivaracetam in the Treatment of Patients with Epilepsy—First Clinical Experiences

et al. 2018

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ObjectivesTo assess first clinical experiences with brivaracetam (BRV) in the treatment of epilepsies.MethodsData on patients treated with BRV from February to December 2016 and with at least one clinical follow-up were collected from electronic patient records. Data on safety and efficacy were evaluated retrospectively.ResultsIn total, 93 patients were analyzed; 12 (12.9%) received BRV in monotherapy. The mean duration to follow-up was 4.85 months (MD = 4 months; SD = 3.63). Fifty-seven patients had more than one seizure per month at baseline and had a follow-up of more than 4 weeks; the rate of ≥50% responders was 35.1% (n = 20) in this group, of which five (8.8%) patients were newly seizure-free. In 50.5% (47/93), patients were switched from levetiracetam (LEV) to BRV, of which 43 (46.2%) were switched immediately. Adverse events (AE) occurred in 39.8%, with 22.6% experiencing behavioral and 25.8% experiencing non-behavioral AE. LEV-related AE (LEV-AE) were significantly reduced by switching to BRV. The discontinuation of BRV was reported in 26/93 patients (28%); 10 of those were switched back to LEV with an observed reduction of AE in 70%. For clinical reasons, 12 patients received BRV in monotherapy, 75% were seizure–free, and previous LEV-AE improved in 6/9 patients. BRV-related AE occurred in 5/12 cases, and five patients discontinued BRV.ConclusionBRV seems to be a safe, easy, and effective option in the treatment of patients with epilepsy, especially in the treatment of patients who have psychiatric comorbidities and might not be good candidates for LEV treatment. BRV broadens the therapeutic spectrum and facilitates personalized treatment.

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Section: Discussionsupporting

confidence: 52%

Brivaracetam in the Treatment of Patients with Epilepsy—First Clinical Experiences

et al. 2018

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“…In regulatory randomized controlled trials conducted in adults, lacosamide has demonstrated to be an effective and safe AED, with 40% of patients with refractory focal epilepsy achieving a 50% reduction in seizure frequency at a short period of time (3 months) [34]. In this review, both retrospective and prospective studies consistently showed efficacy of lacosamide as an add-on therapy in DRE, indicating that the efficacy in children appears to be equivalent to that in adults.…”

Section: Discussionmentioning

confidence: 73%

Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review

Rosa

Ladino

Rodríguez

et al. 2018

Seizure

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Current evidence shows lacosamide as a good option in pediatric patients with focal drug-resistant epilepsy and refractory status epilepticus as an add-on therapy given its efficacy on seizure control and safety profile. The use of lacosamide in Lennox-Gastaut syndrome shows conflicting data. Large randomized controlled studies in the pediatric population are necessary to substantiate these findings.

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“…There are only published data regarding the use of levetiracetam (LEV), topiramate (TPM), pregabaline (PGB), lacosamide (LCM) and perampanel (PER) in RSE and SRSE, but these are limited to small case series. 18,24,25 However, there is a good body of evidence favouring the use of other AEDs, such as valproic acid (VPA), phenytoin (PHT) and phenobarbital (PHB), in earlier SE phases. Therefore, if these were started in previous SE phases, it may be legitimate to maintain them in SRSE.…”

Section: Anti-epileptic Drugsmentioning

confidence: 99%

Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus

et al. 2018

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Introduction: Super-refractory status epilepticus is defined as status epilepticus that persists or recurs 24 hours after anaesthetic therapy onset or after its withdrawal. It is mostly found in intensive care units and carries high mortality but good long-term prognosis for those who survive. In contrast with the initial phases of status epilepticus, treatment lacks strong scientific evidence and is mostly derived from case reports or small case series.Objective: To propose a protocol for the treatment of super-refractory status epilepticus in level III intensive care units, focusing on the treatment strategies to control clinical and/or electroencephalographic epileptic activity.Material and Methods: Narrative review of the literature by PubMed search. Available evidence was discussed in consensus meetings by intensive care and neurology experts’ from a level III intensive care unit and one of the Portuguese reference centres for the treatment of refractory epilepsy, respectively.Results: Anaesthetics with the highest level of evidence are propofol, midazolam, thiopental and ketamine. These represent the basis of the treatment of super-refractory status epilepticus and should be used in combination with antiepileptic drugs. The level of evidence for the latter is lower, however, levetiracetam, topiramate, pregabalin, lacosamide, valproic acid, phenytoin and perampanel may be recommended. Alternative therapeutic strategies with very low level of evidence are recommended in cases of total absence of clinical response, such as magnesium sulphate, pyridoxine, ketogenic diet, therapeutic hypothermia and immunosupression.Conclusion: We propose a treatment protocol based on a sequential combination of anaesthetics, anti-epileptic drugs and alternative therapies. Strategies to evaluate treatment response and to wean drugs based on clinical results are also proposed.

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Lacosamide as adjunctive therapy in refractory epilepsy in adults: A systematic review

Abstract: Based on evidence to date, adjunctive lacosamide is a treatment option to reduce seizure frequency in patients with refractory epilepsy and terminate seizures in patients with RSE. The safety information summary can be used to advise patients of potential adverse effects.

Cited by 29 publications

References 40 publications

Brivaracetam in the Treatment of Patients with Epilepsy—First Clinical Experiences

Brivaracetam in the Treatment of Patients with Epilepsy—First Clinical Experiences

Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review

Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus

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