This meta-analysis aims to assess the efficacy and safety of adjunctive Lacosamide in treating partial-onset seizures.

Almost one-third of patients with epilepsy do not achieve remission, even with appropriate anti-seizure medications. Lacosamide is an antiepileptic drug that has been reported to be productive in managing uncontrolled partial-onset seizures.

We searched PubMed, Cochrane, and Embase for Randomized Controlled Trials that assessed the efficacy and safety of adjunctive Lacosamide for partial-onset seizures. The outcomes of efficacy included the proportion of participants who had a ≥50% and ≥75% decrease in seizure frequency (≥50% and ≥75% response rate). The outcomes of safety included discontinuation due to treatment-emergent adverse events (TEAEs) and incidence of TEAEs. Mantel-Haenszel statistic was used. Risk ratios (RR) were calculated with a 95% confidence interval. Heterogeneity was measured using the I² test. The risk of bias in studies was calculated using Cochrane’s RoB 2 Tool. 

A total of 2836 articles were retrieved and after screening, 7 RCTs (2-8) were included. Lacosamide was associated with a significant increase in the proportion of ≥50% response rate (RR= 1.72 95% CI= 1.45-2.05, p<0.00001, I²=37%) and ≥75% response rate (RR= 2.01, 95% CI= 1.57 – 2.57, p<0.00001, I²= 0%). Lacosamide had a non-significant increase in the incidence of TEAEs (RR= 1.060, 95% CI=0.99 – 1.15, p= 0.09, I²= 42%) but a significant increase in the discontinuations due to TEAEs (RR= 1.83, 95% CI= 1.23 – 2.71, p<0.0001, I²= 26.2%). Almost all the studies had a low risk of bias.

Adjunctive Lacosamide significantly enhances the efficacy of treatment for patients with drug-resistant partial-onset seizures, but clinicians should carefully consider the potential for discontinuation. Future research should focus on identifying the specific factors that contribute to treatment discontinuation, potentially through longitudinal studies that explore patient-reported outcomes and adverse event profiles.