Should lacosamide be discontinued in pregnant women with controlled seizures?

Lacosamide in Pregnancy: Management for Women with Controlled Seizures

Lacosamide should not be discontinued in pregnant women with well-controlled epilepsy, as the risks of seizure recurrence outweigh potential medication risks. 1

Understanding Epilepsy Management During Pregnancy

• Pregnant women with well-controlled epilepsy (those who are treated and stable with no recent history of seizures) should continue their antiepileptic medication, including lacosamide 1
• Seizure control is a critical factor in reducing maternal and fetal morbidity and mortality, making medication continuation essential 1
• Discontinuation of antiepileptic drugs in pregnancy can lead to breakthrough seizures, which pose significant risks to both mother and fetus 1

Rationale for Continuing Lacosamide

• Lacosamide is a newer antiepileptic drug that acts on voltage-gated sodium channels and has demonstrated efficacy in controlling partial-onset seizures 1
• The medication has a favorable pharmacokinetic profile with 100% bioavailability, low protein binding, and minimal drug-drug interactions 2
• For patients whose seizures are well-controlled on lacosamide, maintaining this control during pregnancy is paramount for maternal and fetal safety 1

Safety Considerations

• The most common side effects of lacosamide include dizziness, nausea, diplopia, and headache, which are generally dose-related and more prominent during titration than maintenance 3, 4
• Most adverse events with lacosamide are mild to moderate in intensity, with severe effects predominantly observed only at higher doses (600 mg/day) 3
• While specific pregnancy data for lacosamide is limited, the general principle in epilepsy management is that seizure control takes priority over theoretical medication risks 1

Monitoring Recommendations During Pregnancy

• Regular follow-up visits should be scheduled to assess seizure control throughout pregnancy 1
• Serum levels of lacosamide can be monitored to assess compliance and evaluate potential drug-related side effects 1
• Any worsening of seizure control during pregnancy may require dose adjustments rather than discontinuation 1

Special Considerations

• Physical activity is considered beneficial for pregnant women with well-controlled epilepsy and should be encouraged within guidelines 1
• If seizures remain controlled throughout pregnancy, maintain the current dosage of lacosamide rather than attempting to taper or discontinue 1
• Patients and caregivers should be instructed on seizure management protocols and when to seek medical attention 1

Potential Pitfalls to Avoid

• Abrupt discontinuation of lacosamide in pregnancy can precipitate breakthrough seizures, which carry higher risks than continuing medication 1
• Changing to another antiepileptic medication during pregnancy introduces unnecessary risks if seizures are already well-controlled 1
• Assuming that all antiepileptic drugs have equal risks in pregnancy; management decisions should be based on established seizure control 1

Remember that the primary goal in managing epilepsy during pregnancy is maintaining seizure freedom, as uncontrolled seizures pose greater risks to maternal and fetal health than continued use of antiepileptic medication in women with well-controlled epilepsy 1.