Authors :
Presenting Author: Ryosuke Mizumura, Pharmacist – Saitama Medical University Hospital
Satsuki Watanabe, MD., PhD. – associate professor, Department of Neuropsychiatry, Saitama Medical University Hospital; Akira Ishikawa, Pharmacist – Chief, Department of Pharmacy, Saitama Medical University Hospital; Humihiko Kawai, MD. – Assistant Professor, Department of Neuropsychiatry, Saitama Medical University Hospital; Izumi Kuramochi, MD., PhD. – Assistant Professor, Mental Clinic, Saitama Medical Center; Yoshiko Murata, MD., PhD. – Assistant Professor, Department of Neuropsychiatry, Saitama Medical University Hospital; Hideki Makabe, Pharmacist – Director, Department of Pharmacy, Saitama Medical University Hosipital; Koji Matsuo, MD., PhD. – Professor, Department of Neuropsychiatry, Saitama Medical University Hospital
Rationale:
It has been estimated that about 30% of patients with epilepsy suffer from psychiatric disorders in their life. In Japan, not only neurologists but also neuropsychiatrists diagnose and treat epilepsy. Our group often treats cases of epilepsy combined with psychiatric disorders in the Department of Psychiatry of THE epilepsy center and we need anti-seizure medications with fewer psychiatry-related side effects. Lacosamide (LCM) is generally well tolerated. However, there have been very few studies reporting an influence of LCM on psychiatric comorbidities of epilepsy patients. In this study, we investigated the frequency of psychiatric side effects, influence on comorbid psychiatric disorders, and seizure suppression rate in patients treated with LCM monotherapy.
Methods:
This study is a retrospective, non-interventional chart review of LCM monotherapy patients in the Department of Psychiatry at Saitama Medical University Hospital.
We extracted data from the medical charts of all patients with epilepsy who had been treated with LCM from August 2017 to August 2023 in the Department of Psychiatry in our epilepsy center. We evaluated adverse events, efficacy, and persistence rates. This study was conducted with the approval of the Saitama Medical University Hospital IRB. Results:
Fifty-six patients were included in the study, with a mean age of 45.0 years. A total of 17 patients (36.4%) had comorbid psychiatric disorders. There were four cases of adverse events. A psychiatric symptom-related adverse event was observed in only one case, and that was irritability. The patient had a neurotic disorder and a history of irritability with levetiracetam. There was no significant difference in the incidence of psychiatric symptoms between patients with and without psychiatric comorbidities (
p=0.304). Two patients with comorbid anxiety disorders improved in anxiety after starting LCM, and one of them was able to reduce his anti-anxiety medication. In addition, four patients who had presented irritability with other antiseizure drugs did not develop psychiatric symptoms with LCM. Regarding efficacy, 44 patients (84.6%) were seizure-free, six improved, two remained unchanged, and 0 worsened. There was no significant difference in seizure-free rate between patients with and without psychiatric comorbidities (
p=0.707). The continuation rate was 92.9%.
Conclusions:
Very few patients experienced a psychiatric adverse event caused by LCM regardless of psychiatric comorbidities. In addition, psychiatric symptoms were not worsened by LCM in patients with psychiatric comorbidities, and the seizure suppression effect was not different from that in patients without psychiatric disorders. We have found LCM to be relatively safe to use in patients with a history of irritability with other drugs. This study suggests that LCM is a good option for patients suffering from both epilepsy and psychiatric disorders.
Funding:
There was no funding for this study. Dr.Watanabe has received an honorary lecture fee from DAIICHI SANKYO Co Ltd., UCB Japan Co. Ltd. and EISAI Co. Ltd.