Rational polytherapy with lacosamide in clinical practice: results of a Spanish cohort analysis RELACOVA.

There has been little long-term success with polytherapy for patients with refractory partial-onset epilepsy. The rational combination of antiepileptic drugs based on their mechanism of action may help improve treatment efficacy and tolerability. Lacosamide, a novel sodium channel blocker (SCB), was investigated in 158 patients with partial-onset epilepsy in the prospective, multicenter, observational, RELACOVA cohort study conducted in Spain. After 12 months' treatment with lacosamide, 47% of patients were responders (≥50% reduction in seizure frequency) and 24% were seizure free. Lacosamide was well tolerated; dizziness was the most frequent adverse event. Efficacy was better (responder rate, 65% vs 38%; seizure free rate, 35% vs 17%) and there was a lower adverse event rate (33% vs 58%) in patients receiving non-SCBs (n=49) versus those receiving SCBs (n=104) as concomitant therapy at baseline. Further investigation of lacosamide combination therapy is warranted.

Early add-on lacosamide in a real-life setting: results of the REALLY study.

BACKGROUND AND OBJECTIVES: Many patients with epilepsy are treated with antiepileptic drug (AED) polytherapy. Several factors influence the choice of early add-on therapy, and deciding on the most appropriate drug can be difficult. This study aimed to assess the efficacy and tolerability of lacosamide as early add-on therapy in patients with partial-onset seizures. METHODS: REALLY (REtrospective study of lAcosamide as earLy add-on aLong one Year) was a multicenter, retrospective, 1-year, real-life study. Patients included were aged older than 16 years, had partial-onset seizures, and were treated with lacosamide as add-on therapy after one or two prior AEDs. Data were collected retrospectively from clinical records. The primary study objective was to assess the efficacy of lacosamide over 12 months (seizure-free and responder rates), and the secondary objective was to assess the tolerability of lacosamide at 3, 6, and 12 months [adverse events (AEs) and discontinuation]. RESULTS: One hundred and ninety-nine patients were enrolled in the study; 89 patients (44.7 %) had tried one AED and 110 patients (55.3 %) had tried two AEDs before lacosamide. At 12 months, the proportion of patients who were seizure free was 44.9 %, and 76 % of patients were responders. The seizure-free rate at 12 months for patients who had previously received one or two AEDs was 58 and 34.3 %, and the responder rate at 12 months was 83.0 and 70.4 %, respectively. The AE rate was 21.5 % at 3 months, 27.1 % at 6 months, and 31.2 % at 12 months, with 7.0 % of patients discontinuing treatment because of an AE. The most common AE reported was dizziness (11.6 %). Cryptogenic epilepsy, a higher number of prior AEDs, and the use of a sodium channel blocker at onset were associated with a worse outcome. The number of concomitant AEDs decreased over 1 year (Z = 5.89; p < 0.001). Twenty-two patients were converted to lacosamide monotherapy with at least one evaluation ≥6 months from the beginning of monotherapy conversion. CONCLUSIONS: Lacosamide was effective and well tolerated as early add-on treatment in patients who had received one or two previous AEDs.

[Mental illness, personality traits and quality of life in epilepsy: control study of patients with juvenile myoclonic epilepsy and other epilepsies]. / Enfermedad mental, rasgos de personalidad y calidad de vida en epilepsia: estudio control de pacientes con epilepsia mioclonica juvenil y otras epilepsias.

INTRODUCTION: The association of epilepsy with mental illness is described for years. Current is trying to relate certain epilepsies, such as juvenile myoclonic epilepsy (JME) with certain personality traits marked by emotional instability. SUBJECTS AND METHODS: We study a group of patients with JME and his mental state, with emphasis on the personality traits, presence of clinical anxiety or depression and quality of life, with other epilepsy patients versus a control group. RESULTS: Patients with epilepsy have more marked personality traits and symptoms of anxiety and depression, making a more negative assessment of their quality of life than the control group. Patients with others epilepsy have a higher other personality disorder and a poorer perception of their quality of life than patients with JME. CONCLUSIONS: Differences are obtained among patients with epilepsy and control groups in all the variables analyzed (personality, anxiety, depression and quality of life). JME patients have better scores on personality and quality of life than those in the other group of epilepsies.

TITLE: Enfermedad mental, rasgos de personalidad y calidad de vida en epilepsia: estudio control de pacientes con epilepsia mioclonica juvenil y otras epilepsias.Introduccion. La asociacion de epilepsia con enfermedad mental esta descrita desde hace años. En la actualidad, se intenta relacionar ciertas epilepsias, como la epilepsia mioclonica juvenil (EMJ), con determinados rasgos de personalidad marcados por la inestabilidad afectiva. Sujetos y metodos. Se estudia un grupo de pacientes con EMJ y su estado mental, con especial interes sobre los rasgos de personalidad, la presencia de clinica de ansiedad o depresion, y la calidad de vida, junto con otros pacientes diagnosticados de otras epilepsias, asi como frente a un grupo control. Resultados. Los pacientes con epilepsia presentan rasgos de personalidad mas marcados, asi como sintomas de ansiedad y depresion, y realizan una valoracion mas negativa de su calidad de vida respecto al grupo control. Los pacientes con otras epilepsias presentan una mayor alteracion de la personalidad y una peor percepcion de su calidad de vida que los pacientes con EMJ. Conclusiones. Se obtienen diferencias entre los pacientes con epilepsia y el grupo control en todas las variables analizadas (personalidad, ansiedad, depresion y calidad de vida). Los pacientes con EMJ presentan mejores puntuaciones en personalidad y calidad de vida que los pertenecientes al grupo de otras epilepsias.