Retrospective analysis of the tolerability and activity of lacosamide in patients with brain tumors

Saria, Marlon Garzo; Corle, Courtney; Hu, Jethro; Rudnick, Jeremy; Phuphanich, Surasak; Mrugala, Maciej M.; Crew, Laura K.; Bota, Daniela; Fu, Beverly; Kim, Ryan Y.; Brown, Tiffany; Feely, Homira; Brechlin, Joanne; Brown, Bradley; Drappatz, Jan; Wen, Patrick Y.; Chen, Clark C.; Carter, Bob S.; Lee, Jong Woo; Kesari, Santosh

doi:10.3171/2013.1.jns12397

Cited by 58 publications

(32 citation statements)

References 14 publications

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“…The findings of the present study are in accordance with the results of the retrospective analysis conducted by Saria et al (19), which investigated the efficacy and safety of lacosamide as an add-on AED in 70 patients with primary brain tumors who received lacosamide for seizure activity. Similar to the present study, Saria et al (19) demonstrated that lacosamide was effective and reduced the frequency of seizures in ~66% of patients; lacosamide was additionally demonstrated to be well tolerated, with 77% of patients in the study reporting no toxicity (19). Maschio et al (25) published a preliminary report of the efficacy and tolerability of lacosamide as an add-on therapy in 14 patients with brain tumor-associated epilepsy.…”

Section: Discussionsupporting

confidence: 92%

“…To the best of our knowledge, only a limited number of other studies have investigated the efficacy and safety of lacosamide in a similar patient population (19,25). The findings of the present study are in accordance with the results of the retrospective analysis conducted by Saria et al (19), which investigated the efficacy and safety of lacosamide as an add-on AED in 70 patients with primary brain tumors who received lacosamide for seizure activity.…”

Section: Discussionmentioning

confidence: 99%

“…However, there is data from routine clinical practice that suggests promising efficacy and tolerability in this patient population: A retrospective chart review of 70 patients with brain tumors in the USA found that lacosamide was well tolerated and demonstrated effectiveness when used as an add-on AED treatment (19). The aim of the present study was to investigate the efficacy and tolerability of lacosamide in controlling epileptic seizures in patients with brain tumors in Spain.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and tolerability of lacosamide for secondary epileptic seizures in patients with brain tumor: A multicenter, observational retrospective study

et al. 2017

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The present observational, multicenter, retrospective study investigated the efficacy and tolerability of lacosamide in controlling secondary epileptic seizures in patients with brain tumors in Spain. Data from the medical records of patients ≥18 years of age with brain tumors, who had received at least one dose of lacosamide for seizure management between July 2013 and November 2013, were collected. The primary and secondary objectives of the present study were to assess the effectiveness and tolerability of lacosamide. Data from 39 patients (mean age, 54.1 years; 66.7% male) were collected, where the two main reasons for initiation of lacosamide treatment were the lack of efficacy of other antiepileptic drugs (in 76.9% of patients) and the presence of adverse events (12.8%) associated with other antiepileptic drugs. At the initiation of treatment, patients received a mean lacosamide dose of 138.5±68.3 mg/day. At 6 months, lacosamide had significantly reduced the mean number of seizures from 26.4 (standard deviation [SD], 50.4) seizures for the 6 months prior to lacosamide initiation to a mean of 9.4 (SD, 22.8) seizures during the 6 months subsequent to lacosamide initiation; P<0.001. Lacosamide was generally well tolerated; of the 25 patients who had complete safety data available at a 6-month follow-up, 3 patients (12%) reported an adverse event, including dizziness, asthenia, instability and irritability. The present retrospective analysis suggested that lacosamide is an effective and well-tolerated treatment in patients experiencing seizures due to brain tumors. Additional prospective studies with a larger patient population and randomized trial design are warranted.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and tolerability of lacosamide for secondary epileptic seizures in patients with brain tumor: A multicenter, observational retrospective study

et al. 2017

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“…If either levetiracetam or valproic acid or its combination is insufficiently effective, one can choose lacosamide as add-on agent based on its activity and tolerability in EBT, lamotrigine for its good tolerability and indications of its synergistic activity with valproic acid, or zonisamide, considering its recent designation as class A agent for the partial epilepsies (Brodie and Yuen, 1997; French and Faught, 2009; Glauser et al, 2013; Saria et al, 2013). …”

Section: Antiepileptic Drug Therapymentioning

confidence: 99%

“…Possibly diplopia, dizziness, or drowsiness develops more easily as a pharmacodynamic effect in combination with carbamazepine, phenytoin, or lamotrigine, as these are all sodium channel blockers (Novy et al, 2011). Withdrawal of lacosamide due to cognitive side-effects has been observed in 7.1–15.7% of cases with EBT, and in 27.8% with general epilepsy (Maschio et al., 2011a; Saria et al, 2013; Sawh et al, 2013). …”

Section: Antiepileptic Drug Therapymentioning

confidence: 99%

Epilepsy and brain tumors

Englot

Chang

Vecht

2016

Handbook of Clinical Neurology

173

138

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Seizures are common in patients with brain tumors, and epilepsy can significantly impact patient quality of life. Therefore, a thorough understanding of rates and predictors of seizures, and the likelihood of seizure freedom after resection, is critical in the treatment of brain tumors. Among all tumor types, seizures are most common with glioneuronal tumors (70–80%), particularly in patients with frontotemporal or insular lesions. Seizures are also common in individuals with glioma, with the highest rates of epilepsy (60–75%) observed in patients with low-grade gliomas located in superficial cortical or insular regions. Approximately 20–50% of patients with meningioma and 20–35% of those with brain metastases also suffer from seizures. After tumor resection, approximately 60–90% are rendered seizure-free, with most favorable seizure outcomes seen in individuals with glioneuronal tumors. Gross total resection, earlier surgical therapy, and a lack of generalized seizures are common predictors of a favorable seizure outcome. With regard to anticonvulsant medication selection, evidence-based guidelines for the treatment of focal epilepsy should be followed, and individual patient factors should also be considered, including patient age, sex, organ dysfunction, comorbidity, or cotherapy. As concomitant chemotherapy commonly forms an essential part of glioma treatment, enzyme-inducing anticonvulsants should be avoided when possible. Seizure freedom is the ultimate goal in the treatment of brain tumor patients with epilepsy, given the adverse effects of seizures on quality of life.

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Lacosamide on background eeg activity in brain tumor‐related epilepsy patients: A case series study

Maschio¹,

Zarabla²,

Maialetti³

et al. 2018

Brain and Behavior

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ObjectiveTherapeutic doses of antiepileptic drugs (AEDs) may alter EEG background activity, which is considered an index of the functional state of the brain. Quantitative analysis (qEEG) of EEG background activity is a valid instrument to assess the effects of many centrally active drugs on the central nervous system, including AEDs. Lacosamide (LCM) is a new AED that could be a valid therapeutic choice in patients with brain tumor‐related epilepsy (BTRE).MethodsWe used qEEG to analyze the possible effect of LCM as an add‐on, on background EEG activity after 4 months in patients with BTRE.ResultsWe consecutively recruited sixteen patients with BTRE: Five dropped out for disease progression, five for scarce compliance, and six completed the study. For these reasons qEEG was performed at first visit and after 4 months only in six patients. For all frequency bands, LCM revealed no changes of mean relative power during rest with eyes closed, hyperpnoea (HP), and mental arithmetic task (MA); significant increment was found only in the theta mean relative power during opening and closing eyes (BR). After four months of therapy with LCM, one patient was seizure free, four had a seizure reduction ≥50%, and one showed a worsening in seizure frequency <50%.ConclusionDespite the limitation of a small series, these findings suggest that LCM seems to have only a mild interference on EEG background activity and confirm that LCM has a good efficacy on seizure control in patients with BTRE. This is the first study that evaluates the effect of LCM on background EEG activity, using qEEG in BTRE patients. Future research in this area could include prospective studies with qEEG for a longer follow‐up period to assess the impact of AEDs on brain functions in this particular fragile patient population.

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Retrospective analysis of the tolerability and activity of lacosamide in patients with brain tumors

Cited by 58 publications

References 14 publications

Efficacy and tolerability of lacosamide for secondary epileptic seizures in patients with brain tumor: A multicenter, observational retrospective study

Efficacy and tolerability of lacosamide for secondary epileptic seizures in patients with brain tumor: A multicenter, observational retrospective study

Epilepsy and brain tumors

Lacosamide on background eeg activity in brain tumor‐related epilepsy patients: A case series study

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