Outcome of cancer‐related seizures in patients treated with lacosamide

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Approximately 20%‐80% of patients with cancer will experience a seizure, with primary brain tumors being the ones in which seizures are most frequently seen.1 Traditionally, seizures were treated with classic antiepileptic drugs (AEDs) to prevent recurrences in the short life span of patients with malignant neoplasms. However, patients are surviving longer nowadays due to the development of better antineoplastic treatments, and therefore, the risk of epileptic seizures associated with cancer has also increased. Thus, not only the epileptic seizures but also the chronic effects of the AEDs used to control them may have an impact on the subject.1
Clinical practice guidelines discourage the use of enzyme‐inducing AEDs that may decrease the effectiveness of anticancer treatments.1 In recent years, certain AEDs, such as levetiracetam, carbamazepine, or valproate, have been suggested to increase survival in glioblastomas,3 although no prospective randomized studies have confirmed this hypothesis. In summary, seizure treatment in patients with malignancies should be driven by a number of objectives: (i) reduce seizures; (ii) prevent drug interactions so that anticancer treatment efficacy is not reduced and toxicity is avoided; and (iii) avoid adverse events, both systemic and cognitive, that may undermine the patient's quality of life.1
Lacosamide (LCM) is a third‐generation AED with proven efficacy and safety in patients with focal epilepsy.5 Clinical experiences reported in the literature have shown that LCM can be effective in pediatric population, generalized epilepsy, or even in epileptic encephalopathies such as the Lennox‐Gastaut syndrome.6 However, publications on its use in systemic cancer are scarce. In primary brain tumors treated with LCM, rates of seizure responses vary between 54% and 80% with adverse events reported in less than 23% of patients in all published series.8 LCM has been shown to be well tolerated and effective, with a low rate of drug interactions, even when administered intravenously at high doses to treat serious conditions such as status epilepticus, which makes this drug an interesting treatment option for cancer patients with uncontrolled seizures.
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