The retention of lacosamide in patients with epilepsy and intellectual disability in three specialised institutions

Brenner, Juliëtte; Majoie, H.J.M.; Beek, Sophie van der; Carpay, Johannes A.

doi:10.1016/j.seizure.2017.09.017

Cited by 12 publications

(14 citation statements)

References 29 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%

“…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: Discussionsupporting

confidence: 72%

“…However, in one study in patients with ID aggression/agitation was reported in one fourth of patients. 15 In the present study, behavioral effects were rare but occurred more frequently in patients with ID. Meta-analyses have shown that the occurrence of adverse effects of LCM increases with dose, and withdrawals were often caused by symptoms as dizziness, vertigo, ataxia, and nausea.…”

Section: Efficacy and Tolerabilitymentioning

confidence: 44%

“…In contrast to some other newer AEDs, psychiatric and behavioral adverse effects do not appear to limit the use of LCM. However, in one study in patients with ID aggression/agitation was reported in one fourth of patients . In the present study, behavioral effects were rare but occurred more frequently in patients with ID.…”

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.…”

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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%

“…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: Discussionsupporting

confidence: 72%

Section: Efficacy and Tolerabilitymentioning

confidence: 44%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical experience combined with therapeutic drug monitoring of lacosamide

et al. 2020

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Neue Entwicklungen in der antikonvulsiven Therapie bei Menschen mit Intelligenzminderung

Kerling¹

2022

Z. Epileptol.

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Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies

Strzelczyk

Schubert‐Bast

2022

CNS Drugs

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The developmental and epileptic encephalopathies encompass a group of rare syndromes characterised by severe drug-resistant epilepsy with onset in childhood and significant neurodevelopmental comorbidities. The latter include intellectual disability, developmental delay, behavioural problems including attention-deficit hyperactivity disorder and autism spectrum disorder, psychiatric problems including anxiety and depression, speech impairment and sleep problems. Classical examples of developmental and epileptic encephalopathies include Dravet syndrome, Lennox–Gastaut syndrome and tuberous sclerosis complex. The mainstay of treatment is with multiple anti-seizure medications (ASMs); however, the ASMs themselves can be associated with psychobehavioural adverse events, and effects (negative or positive) on cognition and sleep. We have performed a targeted literature review of ASMs commonly used in the treatment of developmental and epileptic encephalopathies to discuss the latest evidence on their effects on behaviour, mood, cognition, sedation and sleep. The ASMs include valproate (VPA), clobazam, topiramate (TPM), cannabidiol (CBD), fenfluramine (FFA), levetiracetam (LEV), brivaracetam (BRV), zonisamide (ZNS), perampanel (PER), ethosuximide, stiripentol, lamotrigine (LTG), rufinamide, vigabatrin, lacosamide (LCM) and everolimus. Bromide, felbamate and other sodium channel ASMs are discussed briefly. Overall, the current evidence suggest that LEV, PER and to a lesser extent BRV are associated with psychobehavioural adverse events including aggressiveness and irritability; TPM and to a lesser extent ZNS are associated with language impairment and cognitive dulling/memory problems. Patients with a history of behavioural and psychiatric comorbidities may be more at risk of developing psychobehavioural adverse events. Topiramate and ZNS may be associated with negative effects in some aspects of cognition; CBD, FFA, LEV, BRV and LTG may have some positive effects, while the remaining ASMs do not appear to have a detrimental effect. All the ASMs are associated with sedation to a certain extent, which is pronounced during uptitration. Cannabidiol, PER and pregabalin may be associated with improvements in sleep, LTG is associated with insomnia, while VPA, TPM, LEV, ZNS and LCM do not appear to have detrimental effects. There was variability in the extent of evidence for each ASM: for many first-generation and some second-generation ASMs, there is scant documented evidence; however, their extensive use suggests favourable tolerability and safety (e.g. VPA); second-generation and some third-generation ASMs tend to have the most robust evidence documented over several years of use (TPM, LEV, PER, ZNS, BRV), while evidence is still being generated for newer ASMs such as CBD and FFA. Finally, we discuss how a variety of factors can affect mood, behaviour and cognition, and untangling the associations between the effects of the underlying syndrome and those of the ASMs can be challenging. In particular, there is enormous h...

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The retention of lacosamide in patients with epilepsy and intellectual disability in three specialised institutions

Cited by 12 publications

References 29 publications

Clinical experience combined with therapeutic drug monitoring of lacosamide

Clinical experience combined with therapeutic drug monitoring of lacosamide

Neue Entwicklungen in der antikonvulsiven Therapie bei Menschen mit Intelligenzminderung

Psychobehavioural and Cognitive Adverse Events of Anti-Seizure Medications for the Treatment of Developmental and Epileptic Encephalopathies

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