Cardiac Problems as a Side Effect of Lacosamide

In the early view of the journal Epilepsia, Doctors Chinnasami and colleagues from the Department of Clinical and Experimental Epilepsy at the National Hospital for Neurology and Neurosurgery in London, United Kingdom, present a single case report of a side effect that readers should be aware of with regards to the use of Lacosamide. In this particular case a 49-year-old right-handed woman with drug resistant epilepsy had seizures that occurred several times on a daily basis. She was initiated at 50 mg per day of Lacosamide, increasing by 50 mg every week to a dose of 200 mg daily and Zonisamide was eliminated. She was left on a combination of Levetiracetam and Carbamazepine. The patient was noted on video monitoring after her Lacosamide was increased to 500 mg a day to have intermittent pauses on her EKG with a junctional escape route rhythm. She did not have any cardiac symptoms and her past cardiac history was unremarkable. She had a 24-hour holter recording performed that showed episodes of long cardiac pauses with the longest duration being up to six seconds. There were also multiple short sinus pauses with junctional escape rhythms and other abnormalities. Lacosamide was stopped and a 12-lead EKG, ECG monitoring with EEG performed, which showed that the EKG normalized on elimination of the drug.

Although this is a single case study, it is an important reminder about cardiac adverse effects related to drugs. In this case, Lacosamide was the culprit, but other drugs can have cardiac effects as well. Given that seizure medications have a potential impact, keeping cardiac changes in mind is important particularly in people with a known history of cardiac problems and in those with no history, making certain that EKGs are obtained prior to the use of these drugs.