lacosamide / Generic mfg. - LARVOL DELTA

Refractory Status Epilepticus From Severe Hyperammonemia Following TIPS (ACG 2025) - "Despite aggressive treatment—including high-dose benzodiazepines, propofol, levetiracetam, lacosamide, and eventually pentobarbital—the patient remained in refractory status epilepticus. Prompt recognition of severe ammonia elevation, consideration of EEG in unexplained neurologic decline, early initiation of therapies such as CRRT, and downsizing of TIPS if all else fails, may be critical in preventing irreversible outcomes. Increased awareness of this rare but potentially fatal complication is critical for early intervention and may inform future guidelines for post-TIPS monitoring.Figure: Distinguishing Hepatic Encephalopathy from Hyperammonemia-Induced Seizures After TIPS"

Anesthesia • Cardiovascular • CNS Disorders • Epilepsy • Fibrosis • Gastroenterology • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension

PopPK modeling supports BW band dosing of lacosamide for pediatric epilepsy. (PubMed, NPJ Genom Med) - "These findings enabled BW-band dosing as a clinically viable alternative to mg/kg regimens, while CYP2C19 genotyping further enhanced precision. This PopPK-based strategy simplifies LCM therapy without compromising efficacy, offering a practical approach to personalized epilepsy management in children."

Journal • CNS Disorders • Epilepsy • Obesity • Pediatrics • CYP2C19

Efficacy of Lacosamide in Refractory Trigeminal Neuralgia Secondary to Multiple Sclerosis: A single arm open-label trial (IHC 2025) - No abstract available

Clinical • CNS Disorders • Migraine

Role of Medication Reconciliation in Managing Bradycardia: A Rare Cause of Medication-Induced Sinus Bradycardia. (PubMed, Cureus) - "We report the case of a 64-year-old man who was admitted to the intensive care unit for the management of status epilepticus, where he developed new-onset, life-threatening sinus bradycardia, requiring placement on support with two inotropic agents (epinephrine and dopamine) due to persistent hemodynamic instability. Cardiology was consulted as a result, and after extensive workup, including review of past medical conditions, laboratory testing, and telemetry review, including that for reversible etiologies, we identified one of the antiepileptic agents on his medication list as the culprit of his sinus bradycardia. This case serves to contribute to existing, very limited, clinical data on its adverse cardiovascular effects."

Journal • Acute Coronary Syndrome • Cardiovascular • Critical care • Endocrine Disorders • Epilepsy • Infectious Disease

The effects of lacosamide, pregabalin, and tapentadol on peripheral nerve excitability: a randomized, double-blind, placebo-controlled, crossover trial in healthy subjects (NeuPSIG 2025) - "This study validates nerve excitability testing as an effective method for evaluating target engagement of a peripherally acting analgesic. Lacosamide significantly reduced peripheral nerve excitability, particularly in large sensory fibers."

Clinical • CNS Disorders

Antiseizure Medication in Seizure Networks at Early Acute Brain Injury (clinicaltrials.gov) - P4 | N=5 | Terminated | Sponsor: University of North Carolina, Chapel Hill | N=54 ➔ 5 | Active, not recruiting ➔ Terminated; Low recruitment

Enrollment change • Trial termination • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Epilepsy • Hematological Disorders • Vascular Neurology

The Pharmacokinetic and Pharmacodynamic Relationship of Clinically Used Antiseizure Medications in the Maximal Electroshock Seizure Model in Rodents. (PubMed, Int J Mol Sci) - "We assessed the pharmacokinetic/pharmacodynamic (PK/PD) profiles of six ASMs, namely carbamazepine (CBZ), phenytoin (PHT), valproic acid (VPA), lacosamide (LSM), cenobamate (CNB), and retigabine (RTG), using MES models in mice and rats. These results suggest that rats may exhibit greater sensitivity to seizure protection in the MES model, likely reflecting species differences in metabolism and brain penetration. These findings highlight the value of considering concentration-response variations and species-specific differences when assessing the efficacy of both conventional ASMs and novel compounds exhibiting anticonvulsant activity."

Journal • PK/PD data • Preclinical • CNS Disorders • Epilepsy

Focused ultrasound combined with drug-loaded microbubbles suppresses ictal spikes in kainic acid-induced epileptic animals. (PubMed, Ultrason Sonochem) - "This study proposes a novel epilepsy treatment strategy using FUS with ASM- lacosamide-loaded MBs (L-MBs)...This minimally invasive, targeted delivery platform provides a promising alternative for managing drug-resistant focal epilepsy by enhancing focal ASM bioavailability and minimizing systemic adverse effects. Further preclinical and clinical studies are warranted to advance this strategy toward therapeutic application."

Journal • Brain Cancer • CNS Disorders • Epilepsy • Oncology • Solid Tumor

Rapid administration of antiseizure medications: Review of safety, effectiveness, and implications for pharmacy practice. (PubMed, Am J Health Syst Pharm) - "Rapid administration of IVPB lacosamide, levetiracetam, and valproate is safe, and IVP administration of levetiracetam and lacosamide can enhance efficiency."

Journal • CNS Disorders • Epilepsy

Intraoperative ECG Changes Associated With IV Lacosamide During Awake Craniotomy (ASA 2025) - "Although a few case reports describe lacosamide-associated ECG changes, intraoperative occurrences remain undocumented. This case highlights the anesthetic challenges of awake neurosurgical procedures, particularly in managing seizure prophylaxis and unexpected cardiac events."

Anesthesia • CNS Disorders • Epilepsy

The effect of lacosamide in pediatric epilepsy: a correspondence. (PubMed, Int J Surg) - No abstract available

Journal • CNS Disorders • Epilepsy • Pediatrics

SUPER-CAT: Dual Anti-glutamate Therapy in Super-refractory Status Epilepticus After Cardiac Arrest (clinicaltrials.gov) - P=N/A | N=80 | Recruiting | Sponsor: University of Milano Bicocca | Trial completion date: Mar 2025 ➔ Sep 2025 | Trial primary completion date: Mar 2025 ➔ Sep 2025

Trial completion date • Trial primary completion date • Cardiovascular • Epilepsy

Distinct neural coding strategies for evoked versus spontaneous neuropathic pain (NeuPSIG 2025) - "Notably, off-label treatment with the sodium channel modulator lacosamide alleviated pain only in SFN1, concurrently reducing SA and normalizing the heat pain threshold to 48.5°C... The paradox of increased pain with warmth alongside diminished heat pain sensation may be explained by warmth-induced SA in CMi nociceptors coupled with a decreased ability of CM nociceptors to encode acute heat. This suggests that the mechanisms and nociceptor classes involved in spontaneous neuropathic pain differ from those mediating acute, evoked pain. Moreover, the distinct discharge patterns observed in peripheral nociceptors correlate with treatment efficacy, indicating that stratifying parameters in nociceptor discharges might pave the way for more tailored therapeutic approaches."

CNS Disorders • Musculoskeletal Pain • Neuralgia • Pain • NAV1

Xylazine Withdrawal: A Case Report From the Intensive Care Unit to the Medical Ward. (PubMed, Cureus) - "Xylazine is a centrally acting alpha-2 adrenergic agonist commonly used with fentanyl in illicit drug mixtures, yet its withdrawal profile remains poorly characterized...Agitation improved with dexmedetomidine, whereas blood pressure and autonomic control were achieved after initiation of a transdermal clonidine patch, followed by transition to oral clonidine with tapering. The adjunctive use of gabapentin, lacosamide, and quetiapine helped manage psychomotor agitation and generalized pain. The patient recovered to his baseline and was discharged to an outpatient rehabilitation program. This case highlights the importance of recognizing xylazine withdrawal as an independent toxidrome requiring targeted alpha-2 agonist therapy and supports evidence-based, multidisciplinary collaboration for symptom control and clinical stabilization."

Journal • Addiction (Opioid and Alcohol) • Bipolar Disorder • Cardiovascular • CNS Disorders • Critical care • Epilepsy • Hypertension • Infectious Disease • Mood Disorders • Pain • Psychiatry • Psychomotor Agitation • Septic Shock

Authors' response to comment on "Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin, and baclofen". (PubMed, Headache) - No abstract available

Journal • Retrospective data • Neuralgia • Pain

The effects of lacosamide, pregabalin, and tapentadol on peripheral nerve excitability: A randomized, double-blind, placebo-controlled, crossover, multi-center trial in healthy subjects. (PubMed, Anesthesiology) - "This study demonstrates that nerve excitability testing can detect pharmacodynamic effects on large myelinated fibers in healthy subjects. Lacosamide statistically significantly reduced peripheral nerve excitability, particularly in large sensory fibers."

Clinical • Journal • Pain

Cost-effectiveness analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands. (PubMed, Expert Rev Pharmacoecon Outcomes Res) - "A Markov model was used tosimulate lifetime costs and quality-adjusted life years (QALYs) for cenobamatecompared to perampanel, brivaracetam, and lacosamide from the Dutch societalperspective. With the acknowledgment of the limitations, weconcluded that cenobamate is less costly and more effective, which can beconsidered a cost-effective treatment option for patients with drug-resistantfocal seizures in the Netherlands. Future real-world data are needed to confirmour findings."

HEOR • Journal • CNS Disorders • Epilepsy

Effect of Antiseizure Drugs on Growing Bone in Prepubertal Non-Epileptic Rats. (PubMed, Food Chem Toxicol) - "To investigate the histologic effects of topiramate (TPM), lamotrigine (LTG), levetiracetam (LEV), lacosamide (LCM), clobazam (CLB), and zonisamide (ZNS) on rat bone. The HSCORE increased significantly for caspase-3, caspase-9, and Bcl-2-associated X protein (BAX) immunohistochemical staining (p<0.001) and increased significantly in TPM, LTG, LEV, LCM, CLB, and ZNS groups (p<0.001). In summary, the use of antiseizure medications adversely affected the expression of proteins critical to bone physiology in young non-epileptic rats, with varying degrees of impact."

IO biomarker • Journal • Preclinical • CNS Disorders • Epilepsy • BAX • CASP3 • CASP9

Rapid genetic testing in the PICU: uncovering COL4A2-related GOULD syndrome in super-refractory status epilepticus. (PubMed, BMJ Case Rep) - "She was discharged on Clobazam, Perampanel and Lacosamide, with persistent hypotonia and rare myoclonic seizures. While RSE is commonly linked to inflammatory encephalitis, this case emphasises the importance of early genome sequencing, particularly whole-exome sequencing (WES), in cases of acute RSE with no clear underlying aetiology. Early genetic testing is crucial for individualised treatment and genetic counselling, potentially improving patient outcomes."

Journal • CNS Disorders • Endocrine Disorders • Epilepsy • Genetic Disorders • Hypoglycemia • COL4A1

A Hidden Culprit: Insulinoma Masquerading as GLP-1 Agonist-Induced Hypoglycemia (ENDO 2025) - "Here we present a case of recurrent hypoglycemia initiated by tirzepatide use that was ultimately diagnosed to be an insulinoma.Case Presentation: A 56-year-old female with seizure disorder on daily lacosamide and levetiracetam presents for recurrent hypoglycemia throughout the day detected on continuous glucose monitoring (CGM)...CT imaging showed a 1.1 cm lesion in the pancreatic tail, and further evaluation (PET-CT, endoscopic ultrasound) is planned, with surgery as the next step. Tirzepatide, a dual GIP/GLP-1 receptor co-agonist, is used for type 2 diabetes and obesity due to its ability to enhance insulin secretion, promote satiety, and improve glycemic control... This case highlights how GLP-1 agonists can unmask insulinoma-related hypoglycemia and underscores the importance of considering insulinoma in the differential diagnosis during GLP-1 therapy. Early recognition and careful evaluation of unexplained hypoglycemia are key to preventing life-threatening..."

CNS Disorders • Endocrine Cancer • Epilepsy • Genetic Disorders • Hypoglycemia • Metabolic Disorders • Neuroendocrine Tumor • Obesity • Oncology • Severe Hypoglycemia • Solid Tumor • Type 2 Diabetes Mellitus

Trends in Prenatal Exposure to Antiseizure Medications Over the Past Decade: A Nationwide Study. (PubMed, Neurology) - "Despite a sharp shift from valproate to safer ASMs, prenatal exposure to other ASMs with acknowledged or uncertain risks has persisted or even increased, particularly among the most socially disadvantaged populations, requiring additional risk minimization measures."

Journal • CNS Disorders • Developmental Disorders • Epilepsy • Psychiatry

A comparison of the effectiveness of lacosamide and pregabalin in treating patients diagnosed with neuropathic pain: a randomized, controlled, open-label pilot trial. (PubMed, Naunyn Schmiedebergs Arch Pharmacol) - "Despite higher costs, lacosamide is safe and recommended for adults aged ≥ 18 years. Limitations include the open-label design, small sample size, lack of placebo control, and absence of neuropathic pain phenotype analysis, necessitating larger, double-blind trials to confirm findings."

Journal • Neuralgia • Pain

Epilepsy expands the phenotype of L-arginine:glycine amidinotransferase deficiency. (PubMed, Epilepsia) - "This study presents the first cases of epilepsy in AGAT deficiency, suggesting its prevalence may be underestimated. AGAT-related epilepsy appears to be part of the associated developmental encephalopathy, with focal seizures and minimal impact on psychomotor development. In AGAT deficiency, epilepsy is not linked to GAA accumulation as in other creatine deficiency disorders but rather to low brain creatine levels, which may affect γ-aminobutyric acidergic neurotransmission and seizure thresholds. The role of creatine supplementation in seizure control warrants further investigation."

Journal • CNS Disorders • Developmental Disorders • Epilepsy • Mental Retardation • Metabolic Disorders • Myositis

Comment on "Second-line pharmacological treatment strategies for trigeminal neuralgia: A retrospective comparison of lacosamide, gabapentin and baclofen". (PubMed, Headache) - No abstract available

Journal • Retrospective data • Neuralgia • Pain

Development and application of an LC-MS/MS method for 8 antiepileptic drugs and 2 metabolites using microsampling techniques (DBS and VAMS). (PubMed, J Anal Toxicol) - "This study describes the development and validation of an LC-MS/MS method for the determination of 8 AEDs (Carbamazepine, Lacosamide, Levetiracetam, Lamotrigine, Phenobarbital, Valproic acid) and 2 metabolites (10,11-Dihydro-10-hydroxy-carbamazepine (DHCB) and carbamazepine-10,11-epoxide) in DBS and VAMS samples...Some instability issues were detected in DBS samples for oxcarbazepine...The method was applied to 80 paired samples from patients under treatment with these drugs in order to study the suitability of the method for the detection of these compounds, and compare concentrations in paired VAMS, DBS, whole blood and plasma samples. Ratios between paired samples show a promising correlation between microsampling techniques and plasma concentrations."

Journal