Ákos Szabó Charles, Morgan Lola C, Sonnenberg Suzanne, Karkar Kameel M
Department of Neurology and South Texas Comprehensive Epilepsy Center, UT Health San Antonio, San Antonio, Texas.
Epileptic Disord. 2019 Feb 1;21(1):97-101. doi: 10.1684/epd.2019.1032.
Since lacosamide was approved as an adjuvant agent for the treatment of medically refractory focal epilepsy over ten years ago, it is becoming more widely used for the treatment of idiopathic (genetic) generalized epilepsies. Several studies have demonstrated efficacy in reducing primary generalized tonic-clonic seizures (GTCS), but efficacy is less well-characterized for myoclonic and absence seizures. A 29-year-old man with juvenile myoclonic epilepsy and medically refractory GTCS on a combination of levetiracetam and topiramate was started on lacosamide adjunctive therapy with the plan to replace topiramate. While his GTCS became controlled, he was witnessed to have confusional episodes, with waxing and waning responsiveness, lasting a few days, several times a month. After eight months of adjunctive lacosamide therapy, he was admitted to the epilepsy monitoring unit, where paroxysms of generalized spike-and-wave complexes, lasting for 30-90 minutes, were recorded, interrupted only by sleep. During these periods, he demonstrated psychomotor slowing and disorientation on examination. The absence status was successfully broken by lorazepam, and lacosamide was discontinued. The patient had no further confusional episodes at the most recent follow-up visit, four months after discharge.
自拉科酰胺在十多年前被批准作为辅助药物用于治疗药物难治性局灶性癫痫以来，它在特发性（遗传性）全身性癫痫的治疗中应用越来越广泛。多项研究已证明其在减少原发性全身性强直阵挛发作（GTCS）方面的疗效，但对肌阵挛发作和失神发作的疗效特征尚不明确。一名29岁患有青少年肌阵挛癫痫且对左乙拉西坦和托吡酯联合治疗耐药的GTCS男性患者开始接受拉科酰胺辅助治疗，计划停用托吡酯。虽然他的GTCS得到了控制，但有人观察到他出现意识模糊发作，反应时好时坏，持续数天，每月数次。在接受拉科酰胺辅助治疗八个月后，他被收治入癫痫监测病房，记录到持续30 - 90分钟的全身性棘慢复合波阵发，仅在睡眠时中断。在这些发作期间，检查发现他有精神运动迟缓及定向障碍。静脉注射劳拉西泮成功终止了失神状态发作，随后停用了拉科酰胺。出院四个月后的最近一次随访中，患者未再出现意识模糊发作。
