Lacosamide May Be Effective Option for Nocturnal Epilepsy
NFLE, a partial epilepsy syndrome, is characterized by a range of stereotyped motor behavior occurring predominantly or exclusively during sleep. Two types of NFLE—sporadic and autosomal dominant—are recognized. Carbamazepine has been a highly effective treatment for up to 70% of patients. However, a substantial amount of patients with NFLE fail to respond or experience adverse events with standard medications.
To examine the potential for a newer and different sodium-channel mediating agent, a team from the University of Maryland School of Medicine in Baltimore, MD, conducted a retrospective analysis of all patients diagnosed with NFLE from 2008–2011 at the Maryland Epilepsy Center. The investigators assessed patient response to their current treatment who were offered alternatives, including lacosamide, for treatment-resistant or drug-related adverse events. For those given lacosamide, patient responses were evaluated after one year of follow-up.
Among the 18 patients diagnosed with NFLE, 67% reported satisfaction with seizure control and lack of adverse events. Of the remaining six patients, four chose to add lacosamide as adjuvant therapy; however, two discontinued due to intolerable side effects. The remaining two patients experienced better seizure control and tolerability at the one-year follow-up: one patient reported being seizure-free and the other reported experiencing rare, mild episodes when sleep-deprived.
“Based on our preliminary experience, lacosamide, a new sodium-channel mediating agent, may be an alternative treatment for NFLE, and warrants consideration in future prospective studies,” concluded Allan Krumholz, MD, the study's lead author.