First North American Regional Epilepsy Congress: Intravenous or Oral Lacosamide for Patients with Partial Seizures
Speaker: Gregory Krauss, MD, Associate Professor of Neurology, Department of Neurology, Johns Hopkins Hospital Epilepsy Center, Baltimore, Maryland
Intravenous (IV) lacosamide, a new chemical entity being developed as a formulation for the treatment of partial-onset seizures, was observed to be safe, well tolerated, and effective as a short-term replacement for oral lacosamide.
A multicenter, multinational, open-label inpatient trial was conducted to compare IV lacosamide, administered twice daily for two to five days, with oral lacosamide.
A total of 160 patients participating in a lacosamide open-label extension trial for at least eight weeks and who were receiving adjunctive stable twice-daily oral lacosamide 200 to 800 mg/day were eligible for enrollment. Patients received the same dose of IV lacosamide as in the open-label extension trial. They were given a 30-minute infusion (n = 40), a 15-minute infusion (n = 100), and a 10-minute infusion (n = 20). Three patients withdrew from the trial prematurely.
Overall, safety evaluations showed that IV lacosamide was well tolerated both locally and systemically when it was infused over 30, 15, or 10 minutes. Few adverse events were reported.
In this study, the safety profile for lacosamide solution for IV infusion was comparable to oral lacosamide tablets based on analyses of adverse effects, ECG, vital signs, laboratory parameters, and number of seizures.
Oxcarbazepine Monotherapy for Seizure Frequency
Speaker: James Valeriano, MD, Associate Professor of Neurology, Department of Neurology, Drexel University College of Medicine, and Director, Comprehensive Epilepsy Services, and Director, Neurophysiology Laboratory, Allegheny General Hospital, Pittsburgh, Pennsylvania
Oxcarbazepine (Novartis) as monotherapy has been found to control seizure frequency and to be well tolerated in adults with a variety of seizure types.
Twenty-seven patients between 18 and 74 years of age who were treated with were identified in a single-center retrospective chart review between 2000 and 2006. Patients included those who had initiated oxcarbazepine therapy or who were switched to oxcarbazepine because of poor seizure control, poor tolerability, or both. Simple and complex-partial seizures, with or without secondary generalization, and generalized seizures were treated, including complex-partial seizures (14 patients), generalized tonic-clonic seizures (18 patients), and other types (two patients). Some patients had more than one seizure type.
Seizure rates ranged from one or two confirmed seizures (three patients); one to two seizures per year (nine patients); two to four per year (two patients); eight per year (one patient); 24 per year (one patient); 36 per year (one patient); 60 per year (two patients); 60 to 120 per year (one patient); 96 per year (two patients); 2,100 per year (one patient); and 3,600 per year (one patient).
One patient had two seizures during her pregnancy, and one patient was seizure-free. All but four patients had undergone therapy with a wide variety of antiepileptic agents.
After the initiation of therapy or a switch to oxcarbazepine, 16 patients remained seizure-free. Two patients became seizure-free after another antiepileptic drug was added to their regimen; one patient became seizure-free with the addition (Topamax canadian, Ortho-McNeil). The other patient became seizure-free after levetiracetam (Keppra, UCB Pharma) was added.
The daily oxcarbazepine dose ranged from 600 to 2,400 mg/day. The duration of treatment ranged from nine months to five years.
Overall, oxcarbazepine monotherapy was well tolerated. Only one patient discontinued treatment because of fatigue.
Five of the 27 patients were 61 to 74 years of age. These patients were receiving five to nine concomitant medications, and they tolerated oxcarbazepine without adverse effects or hyponatremia.