From the Guidelines
Lacosamide (Vimpat) is favored over levetiracetam (Keppra) in certain situations where its unique pharmacological properties are beneficial, such as in patients with brain tumors who are at risk of seizures and require a medication with a lower potential for drug interactions.
Key Considerations
- Non-enzyme-inducing antiepileptic drugs are preferred in patients with brain tumors to avoid interactions with chemotherapy, targeted therapies, and steroids 1.
- Lacosamide and levetiracetam are both considered non-enzyme-inducing antiepileptic drugs, but lacosamide may be favored in certain situations due to its distinct pharmacokinetic profile 1.
- The choice of antiepileptic drug should be individualized based on factors such as type of seizure, concomitant antineoplastic treatment, age, and comorbidities 1.
- Levetiracetam is generally well-tolerated and may be preferred in some cases due to its established efficacy and safety profile 1.
Clinical Decision-Making
In clinical practice, the decision to use lacosamide over levetiracetam should be based on a careful consideration of the patient's individual needs and circumstances. While lacosamide may offer certain advantages in terms of its pharmacological properties, levetiracetam is a well-established and effective treatment option for seizures in patients with brain tumors. Ultimately, the choice of antiepileptic drug should be guided by the patient's specific clinical profile and the potential benefits and risks of each medication 1.
From the Research
Comparison of Lacosamide and Levetiracetam
- Lacosamide (Vimpat) and levetiracetam (Keppra) are both used in the treatment of epilepsy, but the choice between them depends on various factors.
- According to a study published in 2018 2, lacosamide appears to be as effective as levetiracetam in the treatment of partial onset seizures.
- A 2017 study 3 found that lacosamide can be effectively added to levetiracetam background therapy after down-titration of a concomitant sodium channel blocker, suggesting that lacosamide may be favored in patients who are not adequately controlled on levetiracetam and a sodium channel blocker.
- A 2023 study 4 found that lacosamide is non-inferior to levetiracetam as monotherapy in adult patients with new onset focal epilepsy, suggesting that lacosamide may be a viable alternative to levetiracetam in this population.
- A 2019 study 5 found that lacosamide monotherapy is effective and well-tolerated in elderly patients with focal epilepsy, and may be a valuable option in this population due to its favorable pharmacokinetic profile.
- A 2017 study 6 found that lacosamide is not inferior to levetiracetam in efficacy, but may have a worse tolerability profile at high doses.
Patient-Specific Factors
- The choice between lacosamide and levetiracetam may depend on patient-specific factors, such as:
- Seizure type and frequency
- Age and comorbidities
- Concomitant medications and potential drug interactions
- Tolerability and adverse event profile
- According to the studies, lacosamide may be favored over levetiracetam in patients who: