Lacosamide as a monotherapy for seizures with focal onset

Abstract

Purpose: To assess oral lacosamide's 1-year safety and effectiveness as conversion monotherapy in adult patients with partial onset seizures, whether or not they are generalized. Method: After a year of seizure-free treatment with lacosamide add-on therapy and stopping the concomitant antiepileptic medication, we prospectively monitored a subsequent group of patients who were switched to lacosamide monotherapy (AED). Every three months for up to a year, the incidence of seizures, adherence to therapy, and drug toxicity were evaluated. The retention rate of lacosamide as a single AED and the independence from seizures under lacosamide monotherapy after a year after stopping the baseline AED were the study's outcomes. The frequency of adverse events (AEs) associated with lacosamide served as the safety variable. Results: Out of the 116 patients who were part of the study, 74 (63.8%) continued to take lacosamide as their only antiemetic drug after a year, and 64 (55.2%) did not experience any seizures while on lacosamide monotherapy for the duration of the follow-up. It was found that using less than three AEDs in one's lifetime was a significant predictor of not having seizures (adjusted OR = 6.38, 95% CI 1.85–21.98, p = 0.003). The most prevalent adverse events (20.8%) reported by 24 patients were headache, dizziness, and drowsiness. Conclusion: For a limited group of adult patients with partial onset seizures who had achieved seizure independence while receiving lacosamide add-on medication, switching to lacosamide alone may be both successful and well tolerated.