Outcomes of Patients on Lacosamide Medication During Pregnancy
Abstract number :
2.411
Submission category :
18. Case Studies (case reports and small series less than 5 subjects will not be accepted)
Year :
2022
Submission ID :
2204883
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:27 AM
Authors :
Katelyn Li, – Brigham and Women's Hospital; Elizabeth Shashkova, BS – Neurology – Brigham and Women's Hospital; Regan Lemley, MD – Epilepsy Fellow, Neurology, Brigham and Women's Hospital; Stephanie Allien, PA – Neurology – Brigham and Women's Hospital; Thomas McElrath, MD, PhD – Associate Professor, Obstetrics/Gynecology, Brigham and Women's Hospital; Page Pennell, MD, FAES – Chair of Department of Neurology, Neurology, University of Pittsburgh Medical Center; P. Emanuela Voinescu, MD, PhD – Assistant Professor, Neurology, Brigham and Women's Hospital
This is a Late Breaking abstract
Rationale: Lacosamide (LCM) is a third-generation anti-epileptic drug (AED) that is increasingly prescribed to women of childbearing age due to its ease of administration and limited drug-drug interactions. Though it has been approved as an adjunctive therapy in the treatment of partial-onset seizures since 2008, relatively little is known regarding its effects on pregnancy outcomes. In this case series, we examined in detail the maternal and fetal outcomes, pregnancy-related clearance changes, and seizure frequency of women with epilepsy on lacosamide during pregnancy.
Methods: We included all women with epilepsy on LCM followed at Brigham and Women’s Hospital Epilepsy-Obstetric clinics between January 2019 and June 2022. Clinical data on serum concentration, total daily dose, and time post dose were collected in a longitudinal prospective database. Chart review was performed to obtain additional information on patient demographics, medical history, delivery method, gestational age (GA) at birth, and neurodevelopmental outcomes. Dose-normalized concentration (DNC), defined as AED plasma concentration (μg/mL) / AED total daily dose (mg), was calculated for each serum draw. A repeated-measures analysis of variance was used, with each trimester listed as a categorical variable, to compare DNC values between pregnancy and baseline.
Results: In total, nine pregnancies contained sufficient LCM serum concentration data to be included in the analysis. LCM monotherapy was administered in three pregnancies, while LCM combined with levetiracetam, clonazepam, or brivaracetam was administered in the other six pregnancies. Patient age ranged from 26 to 38 years, and all women had focal epilepsy except for one. Seven pregnancies were seizure-free, one had stable seizure frequency and only one experienced seizure worsening. All nine pregnancies were successful, with babies delivered at > 37 weeks GA and with no major congenital malformation. Two babies were sent to the NICU following birth, due to desaturation and subgaleal hematoma from vacuum delivery respectively. A decreasing trend in DNCs during pregnancy was observed, with an average decrease of 5.8% from baseline in the second trimester and 10.2% from baseline in the third trimester, but differences in DNCs between pregnancy and baseline were not statistically significant (p=0.1775).
Conclusions: Results suggest that LCM, when administered with careful therapeutic dose monitoring, can yield successful pregnancies with limited instances of seizure worsening and fetal complications. Additionally, DNCs exhibited a decreasing trend during pregnancy, confirming that regular, optimized LCM dosage changes may be necessary to achieve the best possible maternal and fetal outcomes. Future analyses in larger cohort sizes are needed.
Funding: Funding for this work was supported by the Karger Fund (P.E.V.).
Case Studies (case reports and small series less than 5 subjects will not be accepted)