Abstracts

Rationale: Many patients with neurologic tumors develop epilepsy and require complex anti-epileptic drug (AED) regimens. Lacosamide has demonstrated tolerability and effectiveness as adjunct therapy for the treatment of partial onset epilepsy. It is both excreted unchanged in the urine and metabolized in the liver by CYP2C19. It has no major pharmacokinetic interactions but studies report pharmacodynamics interactions especially in patients concomitantly taking other voltage gated sodium channel acting AED s. Our objective was to assess the efficacy and tolerability of lacosamide in treating epilepsy due to neurologic tumors.Methods: We queried the University of Colorado adult epilepsy clinical database for patients who had primary or metastatic brain tumors and who were treated with lacosamide between 2010 and the present. Results: Data from a total of nine patients were reviewed. Five patients were women. Mean patient age was 44 +/- 17 years with a range of 22 70 years. Five patients had gliomas and 4 had meningiomas. Two patients had received some form of chemotherapy. Eight patients started lacosamide because of excessive seizures; one because of adverse effects on alternate AEDs. Number of previous AEDs tried ranged from 2-9 (mean: 3.0 +/- 2.2). All patients were on a polytherapy regimen with a mean of 1.7 +/- 0.7 other AEDs. Average total daily dose was 353 +/- 95 mg. One patient had balance problems and 2 had dizziness that were thought to be due to the lacosamide and which decreased with lacosamide dose reduction. Four of the nine patients reported improved seizure control. No patient had to discontinue lacosamide for any reason over an average follow up period of 21 +/- 10 months.Conclusions: None of our patients with brain tumor-related epilepsy discontinued therapy with lacosamide, suggesting that it is well-tolerated in the opinions of patients and healthcare providers. Tolerability in the face of AED polytherapy and a potentially fragile population suggests that lacosamide may be a useful AED for patients with brain tumor-related epilepsy. Saria et al., J. Neurosurg. 2013 v. 118; p 1183. Maschio et al., J. Neurol. 2011 v. 258; p. 2100-4