Efficacy and tolerability of add-on Lacosamide treatment in adults with Lennox-Gastaut syndrome: An observational study.

PURPOSE: To evaluate the efficacy, safety, and tolerability of lacosamide in adults with LGS in the clinical setting. METHOD: The present report is a retrospective, open-label treatment study carried out from June 2013 to December 2014 at the National Institute of Colombia. Lacosamide was introduced as add-on therapy. All caregivers were instructed to initiate lacosamide at low doses (25-50 mg) and gradually increasing it every 2 weeks. The efficacy was evaluated based on the reduction in the rate of each countable type of seizure. We also evaluated the retention rate for lacosamide as the number of days with lacosamide during follow-up. The tolerability was evaluated base on account the adverse events. RESULTS: We found that lacosamide only improves the seizure rate in three out of 19 patients with LGS, in two of them by more than 50%. The highest seizure reduction rate was observed in the focal and tonic-clonic seizures. The most commonly reported adverse events were worsening of seizures, aggressiveness and irritability. Nine patients (47.4%) showed worsening of their behavior during the treatment with lacosamide. CONCLUSION: Lacosamide can exacerbate both, the tonic and astatic seizures, and the encephalopathy associated with this epileptic syndrome. However, it is interesting to consider the likelihood of suppression of generalized tonic-clonic and focal seizures. That is why; lacosamide could be an option after carefully balancing risks and benefits in each individual case.

Suicidal risk and suicide attempts in people treated with antiepileptic drugs for epilepsy.

OBJECTIVE: To determine whether antiepileptic drugs constitute in themselves an independent risk factor for suicidality in patients with epilepsy. METHODS: One hundred and thirty one patients with epilepsy were recruited and followed-up during 5 years. A detailed medical history, neurological examination, EEGs, Mini-International Neuropsychiatric Interview, executive function, and MRI were assessed. Systematically collected data were used to assess suicidality. Multiple regression analysis was carried out to examine predictive associations between clinical variables, psychiatric disorders, antiepileptic drugs and suicidality. RESULTS: We identified two AEDs related with suicide attempts (PHB and LTG) and four with suicidal risk: PHB, PRM, PHT and LTG, but the increased of risk diminished or disappeared when psychiatric comorbidity and other well established risk factors for suicidality were analyzed. We found a significant proportion of patients with depressive episodes associated with Topiramate, Phenitoin, Phenobarbital and Lamotrigine. CONCLUSION: Antiepileptic drugs probably do not have an impact on suicidality.

Cholesterol concentrations and clinical response to sertraline in patients with epilepsy: preliminary results.

OBJECTIVE: Low cholesterol levels are associated with depression and suicide in persons with epilepsy. The goal of this study was to determine whether plasma cholesterol concentration is a predictor of response to sertraline. METHODS: We carried out a prospective open-label study on the efficacy of sertraline as therapy in the treatment of depressive disorder in patients with mesial temporal lobe epilepsy. Patients were treated for 24 weeks at dose levels between 50 and 100mg/day. All patients were evaluated at the beginning of the investigation and 6 months later by two psychiatrists using a structured interview. RESULTS: The mean total cholesterol concentration of nonresponding patients was lower than the mean (SD) cholesterol level of responders [3.2 (0.9) mmol/L vs 5.2 (1.5) mmol/L]; this difference reached statistical significance (P = 0.0000). We found a negative correlation between scores on the Hamilton scale and cholesterol concentrations (r = -33). CONCLUSION: The response to sertraline may depend on the baseline cholesterol concentration.