IJff D M, van Veenendaal T M, Majoie H J M, de Louw A J A, Jansen J F A, Aldenkamp A P
Departments of Neurology and Neuropsychology Epilepsy Centre Kempenhaeghe, Heeze, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
Acta Neurol Scand. 2015 Jun;131(6):347-54. doi: 10.1111/ane.12372. Epub 2015 Jan 28.
Lacosamide (LCM) is a novel antiepileptic drug (AED) with potential benefit as adjunctive treatment in patients with partial-onset seizures. As yet, limited information on cognitive effects of LCM is available, especially in real-life settings.
In this open clinical prospective study, the cognitive effects of LCM were evaluated when used as adjunctive antiepileptic therapy in patients with refractory epilepsy.
We included 33 patients aged between 16 and 74 years (mean: 37 years). All patients had a localization-related epilepsy. Patients were assessed at baseline before starting LCM treatment and during follow-up when the optimal clinical dose was achieved.
Subjective complaints were evaluated using the SIDAED; effects on cognition were evaluated using the computerized visual searching task (CVST).
The CVST showed significant faster information processing reaction times at the second evaluation (P = 0.013), which was not correlated with seizure control, type of epilepsy, age, gender, drug load, number of concomitant drugs, dose or duration of LCM treatment. On the SIDAED, patients complained more about their cognitive function at the second evaluation (P = 0.005). For the SIDAED, a positive correlation at follow-up was found between the total severity score and higher age (r = 0.375, P = 0.031), but not with epilepsy factors or treatment characteristics.
DISCUSSION/CONLUSION: Screening of the cognitive effects of LCM showed that LCM does not have negative effects on information processing speed. As this is the most sensitive function for cognitive side effects of AEDs, LCM does not seem to induce the common negative cognitive effects. Remarkably, patients complained more, especially about their cognitive function, which is possible the 'doing better, feeling worse phenomenon'.
拉科酰胺（LCM）是一种新型抗癫痫药物（AED），作为部分性发作患者的辅助治疗具有潜在益处。迄今为止，关于LCM认知影响的信息有限，尤其是在现实生活环境中。
在这项开放性临床前瞻性研究中，评估LCM作为难治性癫痫患者辅助抗癫痫治疗时的认知影响。
我们纳入了33例年龄在16至74岁之间（平均37岁）的患者。所有患者均患有局灶性相关性癫痫。患者在开始LCM治疗前的基线期以及达到最佳临床剂量的随访期间接受评估。
使用西班牙抗癫痫药物不良反应量表（SIDAED）评估主观症状；使用计算机化视觉搜索任务（CVST）评估对认知的影响。
CVST显示在第二次评估时信息处理反应时间显著加快（P = 0.013），这与癫痫控制、癫痫类型、年龄、性别、药物负荷、合并用药数量、LCM治疗剂量或持续时间无关。在SIDAED上，患者在第二次评估时对其认知功能的抱怨更多（P = 0.005）。对于SIDAED，随访时发现总严重程度评分与较高年龄之间存在正相关（r = 0.375，P = 0.031），但与癫痫因素或治疗特征无关。
讨论/结论：对LCM认知影响的筛查表明，LCM对信息处理速度没有负面影响。由于这是AEDs认知副作用最敏感的功能，LCM似乎不会引起常见的负面认知影响。值得注意的是，患者抱怨更多，尤其是关于他们的认知功能，这可能是“病情好转，感觉更糟现象”。
