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Lacosamide: A Review of Its Use as Adjunctive Therapy in the Management of Partial-Onset Seizures

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Abstract

Lacosamide (Vimpat®) is a functionalized amino acid available orally (as a syrup or tablet) and as an intravenous infusion. It is believed to exert its antiepileptic effect by selectively enhancing the slow inactivation of voltage-gated sodium channels. Lacosamide is approved in several countries worldwide as an adjunctive therapy for the treatment of partial-onset seizures; however, prescribing regulations differ between countries. This article reviews the use of lacosamide as indicated in adults and adolescents (aged 16–18 years) in the EU, where it is approved in this patient population as an adjunctive therapy to other AEDs in the treatment of partial-onset seizures, with or without secondary generalization. In three randomized, double-blind, placebo-controlled, multicentre studies in adults and adolescents (aged 16–18 years) with partial-onset seizures, adjunctive therapy with oral lacosamide (administered for an initial titration period followed by 12 weeks’ maintenance therapy) generally reduced the frequency of seizures to a significantly greater extent than placebo, with antiepileptic efficacy sustained following longer-term treatment (up to 8 years) in this patient population. Oral and intravenous lacosamide were generally well tolerated in clinical studies, with the majority of adverse events being mild or moderate in severity. Very common adverse reactions following adjunctive therapy with oral lacosamide included diplopia, dizziness, headache and nausea; the tolerability profile of intravenous lacosamide appeared consistent with that of oral lacosamide, although intravenous administration was associated with local adverse events, such as injection site discomfort or pain, irritation and erythema. Thus, oral and intravenous lacosamide as an adjunctive therapy to other AEDs provides a useful option in the treatment of patients with partial-onset seizures.

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The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the author(s) on the basis of scientific and editorial merit.

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The manuscript was reviewed by: R.D.C. Elwes, Department of Clinical Neurosciences, King’s College Hospital NHS Foundation Trust, London, UK; A. Husain, Department of Neurology, Duke University Medical Center, Durham, NC, USA; S. Rüegg, Division of Clinical Neurophysiology, Department of Neurology, University Hospital Basel, Basel, Switzerland; V. Villanueva, Unidad Multidisciplinar de Epilepsia, Servicio de Neurología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

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Hoy, S.M. Lacosamide: A Review of Its Use as Adjunctive Therapy in the Management of Partial-Onset Seizures. CNS Drugs 27, 1125–1142 (2013). https://doi.org/10.1007/s40263-013-0123-5

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