Mo F. etal. [650] analyzed data from 132 patients with primary brain tumors treated with LCM monotherapy. Seizure-free rates at 3 and 6months were 64.4% and 55%, respectively. Patients with a history of two or more ASMs had poorer outcomes than those who used LCM as the rst-line medication. The main side effects included dizziness and somnolence, both of which were mild, with a dropout rate of 1.5%. Van Opijnen MP. etal. [333] analyzed 139 patients with grade 2–4 gliomas with seizures in a multicenter study. After failure of rst-line monotherapy with leveti­racetam or valproate, patients received lamotrigine or lacosamide. At 12months, there was no signicant difference in the cumulative incidence of treatment failure with lamotrigine or lacosamide, indicating similar efcacy in patients with neuro­glioma with epilepsy.

The therapeutic effects of lacosamide on cranial nerve diseases have been described. Goldschagg N etal. [657] described a patient with recurrent vertigo, paroxysmal taste disturbances and facial sensory abnormalities whose symptoms signicantly decreased after lacosamide treatment, suggesting its potential as an effective option for paroxysmal taste disturbances and vestibulocochlear nerve lesions. Lacosamide monotherapy also performed well in treating facial pain, with signicant pain improvement and good tolerability observed in three patients with idiopathic trigeminal neuralgia, tumor-related trigeminal neuralgia and persistent idiopathic facial pain without side effects [658]. Muñoz-Vendrell A etal. [659] administered lacosamide to patients with trigeminal neuralgia for whom rst-line treatment failed, and approximately 66% of these patients experienced pain relief and relatively mild adverse effects.

Geng JH. etal. [660] described the rst case of LCM effectively treating an epi­leptic patient with paroxysmal kinesigenic dyskinesia (PKD). The patient had a PRRT2 gene mutation (c.649dupC). Although LEV controlled generalized tonic– clonic seizures, it was ineffective against PKD.Fortunately, the patient’s movement symptoms completely disappeared after LCM was added. Fitouchi S etal. [661] described a 60-year-old male patient with repeated syncope accompanied by olfac­tory or gustatory hallucinations who was diagnosed with limbic encephalitis and treated with lacosamide, resulting in the improvement and disappearance of syn­cope and hallucinations.

The plasma concentration of lacosamide is associated with certain gene muta­tions. Zhao T etal. [680] explored the effect of ABCC2 gene mutations on the blood concentration and efcacy of lacosamide in Uyghur children with epilepsy, nding signicant correlations between gene variance and the plasma concentration–dose ratio, which may lead to drug resistance, and suggested that ABCC2 gene screening should be conducted before LCM treatment, if possible. A study monitoring the blood concentration of lacosamide in adult patients with epilepsy in Korea [681] showed that the therapeutic concentration reference value was 6–9μg/mL, with a linear relationship indicated between concentration and dosage and an association between concentration and the presence of genetic polymorphisms of CYP2C19.

Characteristics oftheDrug

2012. It mainly inhibits the activity of postsynaptic AMPA receptors and reduces the excessive excitability of neurons. It is the rst antiseizure drug approved by FDA whose mechanism of action is against glutamate receptors.

In order to evaluate the clinical efcacy and tolerability, as well as the pharma­cokinetic characteristics of PER in patients with drug-resistant epilepsy, Lossius etal. [695] studied the clinical data of 175 patients with drug-resistant epilepsy, mainly adults, who received PER as an adjuvant treatment at the National Epilepsy Center of Oslo University Hospital in Norway, with an average treatment duration of 16.1months. Forty patients (23%) had a 50% or greater reduction in seizures, four of whom had no seizures, 50 (29%) of whom had no response, and 15 (9%) of whom had an exacerbation of seizures. Logistic regression analysis showed that the efcacy of this drug in treating patients with generalized epilepsy was better than that in the treatment of patients with focal epilepsy. Adverse effects were reported in 135 patients (77%), ranging from mild (34%) to moderate (41%) and severe (2%). These adverse effects led to the discontinuation of PER in 55 patients (41%). The most common adverse effects were psychiatric symptoms (34%), dizziness (31%), and drowsiness (26%). Among the 31 patients for whom serum concentra­tions were available, the mean daily dose of PER was 6.3mg, and the mean steady­state serum concentration was 1.03 μmol/L (0.15–3.59 μmol/L). There was a signicant difference in concentration/dose (C/D) ratios of 12-fold between patients ranging from 0.06 to 0.69 μmol/L/mg, which was associated with the enzyme inducer. The authors suggest that perampanel has a modest seizure reduction effect in this very resistant patient group and that clinicians may consider increasing the dose of PER above 6mg/day in patients with no history of psychiatric illness, hav­ing taken into consideration combination therapy and blood concentration monitoring.