Department of Neurosurgery, Adachi Medical Center, Tokyo Women's Medical University, Tokyo, Japan.
Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan.
Epilepsia Open. 2024 Oct;9(5):1956-1961. doi: 10.1002/epi4.13018. Epub 2024 Aug 14.
Carbamazepine (CBZ) use has been limited by multiple adverse reactions. Lacosamide (LCM) is a functional amino acid anti-seizure medication (ASM), approved for focal seizure patients more than 4 years old. It is non-inferior in terms of efficacy to controlled release CBZ and was proven to have better tolerability. This study examines the effect of abruptly changing CBZ to LCM in epilepsy patients with elevated gamma-glutamyl transpeptidase (GGT). Consenting adult patients aged 18 years old and above, with controlled focal seizure disorder for more than 2 years, who were consistently taking CBZ and who had elevated GGT were included in this study. Out of 1526 patients screened, only 12 satisfied the inclusion criteria. After abruptly changing CBZ to LCM, the GGT level significantly dropped from a median of 141.5 to 63.5 IU/L (z = 3.06, p = 0.0005). Moreover, there was significantly lower proportion of patients with abnormal GGT levels after the switch in medications was done (100% vs. 66.7%, McNemar χ = 8, p = 0.008). Moderate to high levels of GGT in patients with focal epilepsy can be decreased by changing CBZ to LCM. Moreover, abruptly changing CBZ to LCM without cross-titration may be safe and effective in preventing seizure incidence within a 1-month period. PLAIN LANGUAGE SUMMARY: Although carbamazepine (CBZ) is the standard drug for focal seizures, its numerous side effects, especially in the liver, limits its use in a lot of patients with epilepsy. Gamma-glutamyl transferase (GGT), which is elevated in liver disease of whatever cause including intake of CBZ, is associated with increased mortality. In this study, we found that abruptly changing CBZ to Lacosamide (LCM) can significantly decrease the GGT level in 1 month without apparent increase in seizure recurrence and side effects. Therefore, we conclude that high levels of GGT may be decreased by abruptly changing CBZ to LCM.
卡马西平 (CBZ) 的使用受到多种不良反应的限制。拉科酰胺 (LCM) 是一种功能性氨基酸抗癫痫药物 (ASM)，已批准用于 4 岁以上的局灶性癫痫患者。它在疗效上与控释 CBZ 无差异，并且被证明具有更好的耐受性。本研究探讨了在谷氨酰转肽酶 (GGT) 升高的癫痫患者中突然将 CBZ 转换为 LCM 的效果。这项研究纳入了年龄在 18 岁及以上、有 2 年以上控制良好的局灶性癫痫发作病史、持续服用 CBZ 且 GGT 升高的成年患者。在筛选出的 1526 名患者中，仅有 12 名符合纳入标准。在突然将 CBZ 转换为 LCM 后，GGT 水平从中位数 141.5IU/L 显著降至 63.5IU/L(z=3.06，p=0.0005)。此外，在转换药物后，GGT 水平异常的患者比例显著降低(100%比 66.7%，McNemar χ²=8，p=0.008)。在局灶性癫痫患者中，GGT 水平升高可通过将 CBZ 转换为 LCM 来降低。此外，在 1 个月内无需交叉滴定就将 CBZ 突然转换为 LCM，在预防癫痫发作方面可能是安全且有效的。
