Adjunctive Therapy with Lacosamide for Older Epilepsy Patients (P06.115)

Abstract

Objective: To examine the outcome of adjunctive therapy with lacosamide (LCS) in older epilepsy patients. Background As only 18 elderly patients were enrolled in the LCS partial-onset clinical trials, the effectiveness for this cohort is relatively unknown. Also, the pharmacokinetics differ (20% higher AUC and C max values are observed in healthy elderly vs. younger controls), but the clinical significance has not been determined. LCS can rarely induce conduction abnormalities (asymptomatic 1 st degree AV block in epilepsy trials and atrial fibrillation/flutter in diabetic neuropathy trials). Older patients with these comorbidities may be at higher risk. Design/Methods: A retrospective chart review identified patients > 50 yo on LCS. Relevant clinical factors were collected for those with documented pre-treatment and post-treatment seizure frequencies. Total mean seizure frequency 3 mo before initiation and at last follow-up were calculated, and the 50% responder rates were determined. Reason for discontinuation was classified as due to ineffectiveness or AE. Results: Thirty subjects with mean seizure onset/LCS start of 30.79 yrs (0-82) and 61.3 yrs (50-84) were included. Epilepsy syndrome was partial for all but one. Twenty-seven had failed > 2 past AED trials. Two had coronary artery disease and one diabetes. In the last 3 treatment months, 18 (60%) had > 50% total seizure reduction and 9 (30%) were seizure-free. Mean treatment duration/mean dose was 12.8 mo and 219 mg. Fourteen (47%) had AE9s: CNS-related were most common (dizziness/sedation). Seven (23%) withdrew: 4 (13%) due to AE9s (none cardiac-related). Conclusions: LCS was effective in this sample and comparable to previous studies. Although CNS-related AE9s were common, the rate of withdrawal due to AE9s was no higher than previous studies. No cardiac AE9s occurred. Combination with a sodium channel blocker (SCB) or LEV was not associated with treatment outcome as previously seen. Additional study in a larger sample is warranted. Disclosure: Dr. Fertig has nothing to disclose. Dr. Fleming has nothing to disclose. Dr. Feoli has nothing to disclose. Dr. Ghacibeh has received personal compensation for activities with UCB Pharma as a speaker. Dr. Laban has received personal compensation for activities with UCB Pharmaceuticals as a speaker. Dr. Lambrakis has nothing to disclose. Dr. Mesad has nothing to disclose. Dr. Politsky has received personal compensation for activities with UCB, Novartis, GlaxoSmithKline, Ortho-McNeill, and Eisai as a speaker and consultant.Dr. Politsky has received research support from UCB Pharmaceuticals, Cyberonics, Glaxo-Smith-Kline, and Neuropace Inc. Dr. Lancman has received research support from UCB Pharmaceuticals.