The high incidence and risk factors of levetiracetam and lacosamide-related skin rashes in glioma patients
Mikoto OnoderaTaiichi SaitoAtsushi FukuiMasayuki NittaShunsuke TsuzukiShunichi KoriyamaKen MasamuneTakakazu KawamataYoshihiro Muragaki
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Keywords:
Lacosamide
Levetiracetam
Lacosamide
Levetiracetam
Piracetam
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Objective:
To analyze the efficacy of IV lacosamide versus levetiracetam as an early therapeutic treatment for Non-Convulsive Status Epilepticus.Background:
Nonconvulsive status epilepticus (NCSE) is a subset of status epilepticus (SE) characterized by behavioral changes or cognitive impairment. Studies investigating lacosamide and levetiracetam for the treatment of NCSE have consistently demonstrated promising efficacy, but the quantity of research has been lacking. We aimed to assess and compare the efficacy of IV lacosamide and levetiracetam when used in early treatment of NCSE utilizing a cohort of patients that is larger than any known single-center study.Design/Methods:
We retrospectively reviewed medical records of patients diagnosed with NCSE at Miami Valley Hospital from 2012–2016 that were treated with IV lacosamide (33 patients) or levetiracetam (66 patients). We compared efficacy of both drugs and the effectiveness of their standard doses: lacosamide (200–400mg IV bolus) and levetiracetam (500mg BID). Statistical analyses were completed by a statistician using SPSS software on de-identified and coded data.Results:
Lacosamide was shown to be more effective (p-value <0.001) using a chi-square test when analyzing the percent of patients whose status was improved after the first administration of levetiracetam versus lacosamide. While levetiracetam showed clinical improvement of patients at the third administration (p-value<0.001). When given at a therapeutic level as a first dose or second dose, lacosamide proved to be more effective (p-value=0.003) for the first dose and second dose (p-value=0.009) using a chi-square test. However, levetiracetam was found to be more effective when given as a third medication (p-value=0.005) with chi-square test and Fisher’s exact test (p=0.034) respectively.Conclusions:
Overall, lacosamide was more effective than levetiracetam when given as the first medication administered for NCSE. While, levetiracetam was found to be more effective as a third line agent or later. Our study provides evidence for lacosamide to be a future therapeutic option in the treatment of NCSE in comparison to a well-known control, levetiracetam. Disclosure: Ms. Payne has nothing to disclose. Dr. Mustafa has nothing to disclose. Mr. Wiedemer has nothing to disclose. Ms. Liu has nothing to disclose. Dr. Kentris has nothing to disclose.Lacosamide
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Abstract Lacosamide (LCM) due to no known drug interaction and the absence of metabolic enzyme induction is a good candidate for an add-on medication, especially in combination with lamotrigine, levetiracetam (LEV), oxcarbazepine, topiramate, and valproic acid (VPA). Here we report for the first time, to our knowledge, that LCM can lower VPA and LEV serum levels. At present, there are no known explicable mechanisms of action of LCM, which lowers VPA and LEV. Here observed drug interaction of LCM is of clinical significance, which might be useful for other colleagues in the field.
Lacosamide
Levetiracetam
Oxcarbazepine
Valproic Acid
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Background: Lacosamide (LCM) has no known drug interaction or metabolic enzyme induction and is, thus, a good add-on medication. Here we report for the first time that LCM can lower valproate (VPA) and levetiracetam (LEV) serum levels.
Lacosamide
Levetiracetam
Piracetam
Antiepileptic drug
Valproic Acid
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Background and Aim . Levetiracetam is a second-generation antiepileptic drug. It is approved as an adjunctive treatment of partial onset seizures with or without secondary generalization. It is considered safe with less than 1% of patients with transient elevations of liver enzymes. Methods . We report a case of acute liver failure secondary to Levetiracetam in combination with Lacosamide documented with a liver biopsy. Results . Liver biopsy demonstrated acute liver injury with a predominant submassive necrosis pattern and features of a drug-induced hepatitis. Conclusions . This is the first published case of acute liver failure due to antiepileptic therapy with Levetiracetam in combination with Lacosamide.
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Levetiracetam
Antiepileptic drug
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Background Lacosamide is indicated for various types of refractory epilepsy and as adjunctive therapy to other antiepileptic medications. Data on monitoring serum levels of lacosamide in pediatric patients is scarce. Objective To evaluate the correlation between serum levels of lacosamide and the tolerability in children with refractory epilepsy. Methods The medical records of 22 children with refractory epilepsy treated with lacosamide at Assaf Harofeh Medical Center were reviewed. Trough serum levels of lacosamide was measured using HPLC and correlated with its efficacy and safety. Results Mean age of the children was 11 ± 4 (3–18) years. Median lacosamide daily dose was 9.3 (6.6–11) mg/kg and median plasma concentration was 7.1 (5.9–11.9) ug/ml. The therapeutic range of lacosamide serum concentration is 10 to 20 ug/ml. No change in seizures frequency was reported in 21.4% of children with lacosamide concentrations below 10 ug/ml. However, in 40% of the children, reduction of the seizures frequency was reported when serum concentration was above 10 ug/ml. No serious adverse events were reported during therapy. The prospective part of the study was initiated, and the first patients were recruited. Conclusion Large studies, preferably prospective, on lacosamide serum monitoring including information on correlation with efficacy and safety are warranted. Disclosure(s) Nothing to disclose
Lacosamide
Tolerability
Refractory (planetary science)
Medical record
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Lacosamide
Refractory (planetary science)
Antiepileptic drug
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Levetiracetam
Lacosamide
Discontinuation
Antiepileptic drug
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Lacosamide
Levetiracetam
Perampanel
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Abstract Background The number of patients with epilepsy receiving perampanel or lacosamide as an add-on treatment following levetiracetam treatment has increased. Although levetiracetam causes psychiatric disorders, it is unclear whether they occur with the combined use of these antiepileptic drugs. Objective To determine the frequency of psychiatric disorders in patients using lacosamide or perampanel as an add-on therapy to levetiracetam. Setting A single-center retrospective cohort study. Methods Patients who received levetiracetam, lacosamide, and perampanel between April 1, 2014 and April 30, 2019 in Hachioji Medical Center were selected. They were classified into the levetiracetam+lacosamide or levetiracetam+perampanel group. Medical records from the start of combination therapy contained patient background and the incidence of psychiatric disorders. Main outcome measure Onset of psychiatric disorders. Results Forty-four patients used levetiracetam+lacosamide and 50 used levetiracetam+perampanel. The incidence of psychiatric disorders was significantly lower (p = 0.000047) with levetiracetam+lacosamide (6.8%) than with levetiracetam+perampanel (46%). The time to the onset of psychiatric disorders was within 1 month of dose initiation or increase in one case (33.3%) with levetiracetam+lacosamide and 16 cases (76.2%) with levetiracetam+perampanel. The median time to onset was 56 and 6.5 days with levetiracetam+lacosamide and levetiracetam+perampanel, respectively. There was no significant difference in antiepileptic drug dosages owing to the presence or absence of psychiatric disorders. Conclusion As the frequency of psychiatric disorders was higher with levetiracetam+perampanel therapy, levetiracetam+lacosamide may be preferable. These disorders tended to develop within 1 month of therapy and were not dose-dependent. Antiepileptic drugs should be cautiously prescribed to avoid psychiatric disorders.
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Levetiracetam
Perampanel
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