Lacosamide in patients with intellectual disability and refractory epilepsy

Kleist, Anika; Kerling, Frank; Hamer, Hajo M.; Winterholler, Martin

doi:10.1007/s13760-019-01098-3

Cited by 14 publications

(16 citation statements)

References 36 publications

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“…The predicted time to discontinuation of more than 40 months was, however, not significantly different. Retention rates of LCM in patients with ID have previously been investigated in several studies [14][15][16][17] with similar results as in our study, but this is the first study that directly compares ID patients with a non-ID group, also including TDM data.…”

Section: Discussionsupporting

confidence: 79%

“…This is in line with other studies, where this possible pharmacodynamic interaction resulted in an increased burden of CNS-related adverse effects in the patients using such combination. 16,21 Our study also indicates that patients being less tolerant or experience poorer efficacy of other sodium channel blockers were more likely to stop their medication with LCM. This is probably due to the epileptogenesis and a group of patients that are sensitive to sodium channel blockers.…”

Section: Efficacy and Tolerabilitymentioning

confidence: 57%

“…The predicted time to discontinuation of more than 40 months was, however, not significantly different. Retention rates of LCM in patients with ID have previously been investigated in several studies with similar results as in our study, but this is the first study that directly compares ID patients with a non‐ID group, also including TDM data. The results show a similar exposure of LCM in both groups, pointing to the same degree of follow‐up and monitoring, which increases the impact of the study.…”

Section: Discussionmentioning

confidence: 80%

“…There was a significant increased risk of withdrawal of LCM among those who used other sodium channel‐blocking AEDs. This is in line with other studies, where this possible pharmacodynamic interaction resulted in an increased burden of CNS‐related adverse effects in the patients using such combination …”

Section: Discussionmentioning

confidence: 99%

“…11,12 Thus, there is little evidence-based data concerning the appropriate use of new AEDs in this patient group, where communication barriers make it more difficult to achieve an optimal balance between seizure control and adverse effects. 13 There are some retrospective studies regarding the use of LCM in patients with ID, [14][15][16][17] but therapeutic drug monitoring (TDM) was not included as part of the evaluation in these studies.…”

mentioning

confidence: 99%

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Clinical experience combined with therapeutic drug monitoring of lacosamide

et al. 2020

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Objective Lacosamide (LCM) is an antiepileptic drug (AED) with insufficient clinical experience in patients with intellectual disability (ID). They often have more severe epilepsy with comorbidities. The objective was to evaluate the efficacy and tolerability of lacosamide (LCM) in patients with refractory epilepsy with and without ID in a real‐life setting, taking drug monitoring (TDM) data into account therapeutic. Methods Retrospectively, we identified 344 patients using LCM from the TDM service covering the majority of the country, at the National Center for Epilepsy in Norway (2013‐2018). Clinical and TDM data were available for 132 patients. Results Forty‐four of the 132 patients (33%) had ID. The retention rate was significantly higher in the ID vs the non‐ID group after 1 year (84% vs 68%, P < .05). By combining clinical and TDM data, we demonstrated that 37/38 responding patients had serum concentrations above the lower limit of the reference range (>10 µmol/L), and 16/17 with lower concentrations were non‐responders. Mean serum concentration/dose ratios were similar in both groups, 0.06 and 0.07 µmol/L/mg. There were no significant differences regarding efficacy and tolerability. The risk of LCM withdrawal was significantly higher when LCM was added to sodium channel blockers, even if the latter was discontinued. Significance Lacosamide was generally well tolerated in patients with drug‐resistant epilepsy, where one third had ID, and in these patients the retention rate was higher. The combination of clinical and TDM data could possibly facilitate LCM therapy in these vulnerable patients.

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Section: Discussionsupporting

confidence: 79%

Section: Efficacy and Tolerabilitymentioning

confidence: 57%

“…The predicted time to discontinuation of more than 40 months was, however, not significantly different. Retention rates of LCM in patients with ID have previously been investigated in several studies with similar results as in our study, but this is the first study that directly compares ID patients with a non‐ID group, also including TDM data. The results show a similar exposure of LCM in both groups, pointing to the same degree of follow‐up and monitoring, which increases the impact of the study.…”

Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%