将传统的钠通道阻滞剂转换为左乙拉西坦治疗癫痫患者。

Switching from traditional sodium channel blockers to lacosamide in patients with epilepsy.

机构信息

Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea.

Department of Neurology, National Medical Center, Seoul, South Korea.

出版信息

Seizure. 2019 Feb;65:172-175. doi: 10.1016/j.seizure.2019.01.027. Epub 2019 Jan 30.

DOI:10.1016/j.seizure.2019.01.027

PMID:30721874

Abstract

PURPOSE

Lacosamide (LCM) is a recently developed sodium channel blocker (SCB), which acts mainly on the slow activation state in sodium channels. Although LCM shares a range of dose-dependent adverse effects with traditional SCBs, it has several advantages in that it does not induce hepatic drug metabolizing enzymes and has less risk of drug interactions and idiosyncratic adverse effects.

METHODS

We retrospectively analyzed the efficacy and tolerability of switching from traditional SCBs to LCM. The reason for the switch was classified as insufficient efficacy, adverse effects, or concern about metabolic derangement, resulting in conditions such as atherosclerosis and osteoporosis, with long-term use of traditional SCBs.

RESULTS

Seventy-five patients were switched to LCM from traditional SCBs. The overall rate of successful switching was high (81.3%, 61/75 patients). However, the success rate was strongly dependent on the reason for the switch; patients with insufficient efficacy on SCBs had less chance of a successful switch (71.8%, 28/39 patients) than those with adverse effects (89.5%, 17/19) or concerns about metabolic derangement (94.1%, 16/17, p = 0.038). Patients with insufficient efficacy were significantly younger (p = 0.004) and had a higher chance of drug-resistant epilepsy (p = 0.004) than those in the other two groups.

CONCLUSIONS

Our study shows that switching from traditional SCBs to LCM is usually successful and the likelihood of a successful switch is higher in patients when the reason for the switch is adverse effects or concerns about metabolic derangement on traditional SCBs.

摘要

目的

拉考沙胺（LCM）是一种新开发的钠通道阻滞剂（SCB），主要作用于钠通道的缓慢激活状态。尽管 LCM 与传统 SCB 具有一系列剂量依赖性不良反应，但它具有一些优势，即不会诱导肝药物代谢酶，并且药物相互作用和特发性不良反应的风险较低。

方法

我们回顾性分析了将传统 SCB 转换为 LCM 的疗效和耐受性。转换的原因分为疗效不足、不良反应或对代谢紊乱的担忧，这些情况导致了动脉粥样硬化和骨质疏松等疾病，长期使用传统 SCB 会导致这些情况。

结果

75 例患者从传统 SCB 转换为 LCM。总的转换成功率很高（81.3%，61/75 例）。然而，成功率强烈取决于转换的原因；SCB 疗效不足的患者转换成功率较低（71.8%，28/39 例），而不良反应（89.5%，17/19 例）或对代谢紊乱的担忧（94.1%，16/17 例）的患者转换成功率较高（p=0.038）。疗效不足的患者明显更年轻（p=0.004），并且更有可能患有耐药性癫痫（p=0.004）。