Anwendungsbeobachtung von Lacosamid als Monotherapie in der Epilepsiebehandlung

Die Diagnose Epilepsie erfordert eine effektive Behandlung, um die Morbidität der Patienten zu verringern und die Lebensqualität zu erhalten. Mit der richtigen Therapie hat ein Patient in 70 % der Fälle die Chance anfallsfrei zu werden. Besonders hoch ist mit 61,8 % die Wahrscheinlichkeit einer Anf...

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Bibliographic Details
Main Author: Krombholz, Elena
Contributors: Menzler, Katja (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2022
Online Access:PDF Full Text
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Diagnosis of epilepsy requires effective treatment to reduce patient morbidity and maintain quality of life. With the right therapy patients have the chance to become seizure-free in 70 % of cases. At 61.8 %, the probability of seizure-free treatment with the first prescribed drug is particulary high. This decreases with each additional ASD. The treatment of the disease with a monotherapy is essential to avoid interactions due to many concomitant medications and associated side effects. The aim of this study was to gain clinical experience with the application of the antiseizure drug lacosamide in monotherapy in epilepsy treatment at a clinical center. Efficacy and tolerability were analyzed over a period of approximately 6 to 12 months. A total of 50 patients were included and all patients were older than 18 years. Overall, more women than men were treated with lacosamide and the mean duration of disease at the start of the therapy was 8.31 years. Initially, 58 % of patients were classified as pharmaco-resistant. We included patients with a first-line therapy with lacosamide, patients who switched to lacosamide from a previous monotherapy with another ASD and patients who had previously received lacosamide as add-on treatment. In 11 cases only one follow-up after 4 to 6 months could be taken into account, in all other cases an appointment could be included after about one year. The outcome compared to the baseline group showed significant group differences (x2=9.50, p=.023, n=48) with 12 (25 %) patients who continued to be seizure-free, 19 (40 %) patients who gained seizure freedom after treatment with lacosamide, 4 (8 %) patients without final seizure freedom and 13 (24 %) patients with unchanged seizure frequency. Thirteen patients showed side effects under the therapy with lacosamide, four of whom had to stop the monotherapy due to the side effects. The reasons included itching, mood swings, swollen eyes and hair loss. In total 14 patients (29 %) stopped the monotherapy with lacosamide. Reasons were predominently the occurrence of side effects or no efficiency. Overall lacosamide was well tolerated, as the side effects that occurred did not lead to major complications or to a discontinuation in the majority of the cases. Although seizure freedom was achieved in 19 patients, lacosamide in monotherapy showed a high discontinuation rate of 29 %. In order to obtain a more meaningful assessment of lacosamide in monotherapy, studies with larger groups of patients are recommended. To better asses the relationship between side effects and lacosamide, a prospective approach has certainly an advantage over a retrospective study.