Long-term safety and efficacy following conversion to eslicarbazepine acetate monotherapy in adults with focal seizures

Sodium channel blockers for the treatment of focal epilepsy: A Chinese expert consensus

PURPOSE

To provide consensus-based recommendations for the use of sodium channel blockers (SCBs) in the management of focal epilepsy.

METHODS

A three-round modified Delphi procedure was conducted among a Delphi panel of 24 Chinese experts to build a consensus. A steering committee developed 9 statements related to SCBs for the treatment of focal epilepsy, and these statements were evaluated and voted upon by the expert panel.

RESULTS

The expert panel achieved consensus on nine statements regarding the treatment recommendations for oxcarbazepine, lamotrigine, lacosamide, eslicarbazepine, topiramate, zonisamide and cenobamate in focal epilepsy patients and treatment adjustments for SCBs.

CONCLUSION

This is a Chinese expert consensus on the use of SCBs in focal epilepsy developed using the modified Delphi method. These recommendations can help clinicians in their practice and guide future research.

Hyponatremia With Anticonvulsant Medications: A Narrative Review

Hyponatremia is an adverse effect of many antiseizure medications (ASMs). It occurs with interference with the normal balance of electrolytes within the body. Various risk factors associated with the development of hyponatremia in patients taking these medications include age, gender, dosage, and combinations with other drugs. ASMs such as carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid have a higher risk of hyponatremia. Hyponatremia induced by an antiseizure medication can occur through various mechanisms depending on the drug's specific mechanism of action. Hyponatremia can be a potentially fatal side effect. Patients taking these medications need to be monitored closely for the signs and symptoms of hyponatremia. Acute hyponatremia, defined as developing in <48 hours, is more likely to show symptoms than chronic hyponatremia. Signs of acute hyponatremia include delirium, seizures, decerebrate posturing, and cerebral edema with uncal herniation. Chronic hyponatremia, defined as developing in >48 hours, can cause lethargy, dizziness, weakness, headache, nausea, and confusion. Hyponatremia is associated with longer hospital stays and increased mortality. Treatment varies based on the degree of severity of hyponatremia. Choosing a treatment option should include consideration of the drug causing the electrolyte disturbance, the patient's risk factor profile, and the severity of symptoms as they present in the individual patient. Healthcare providers should be aware of hyponatremia as a potential side effect of ASMs, the signs and symptoms of hyponatremia, the different treatment options available, and the potential complications associated with rapid correction of hyponatremia.

Eslicarbazepine-induced severe hyponatremia resulted in generalized tonic-clonic seizure

Although eslicarbazepine is an anti-seizure medication, it may result in seizure worsening if its use is complicated by severe hyponatremia, even long time after commencing this medication. The treatment is a replacement for another ASM.

Long-term efficacy and safety of eslicarbazepine acetate monotherapy for adults with newly diagnosed focal epilepsy: An open-label extension study

Objective

To assess the efficacy, safety, and tolerability of eslicarbazepine acetate (ESL) monotherapy during long‐term treatment.

Methods

An open‐label extension (OLE) study was conducted in adults completing a phase 3, randomized, double‐blind, noninferiority trial, during which they had received monotherapy with either once‐daily ESL or twice‐daily controlled‐release carbamazepine (CBZ‐CR) for newly diagnosed focal epilepsy. In the OLE study, all patients received ESL (800‐1600 mg/d) for 2 years. Primary efficacy outcome was retention time (from baseline of the OLE study). Secondary efficacy assessments included seizure freedom rate (no seizures during the OLE study) and responder rate (≥50% seizure frequency reduction from baseline of double‐blind trial). Safety assessments included evaluation of treatment‐emergent adverse events (TEAEs).

Results

Of 206 randomized patients, 96 who received ESL in the double‐blind trial (ESL/ESL) and 88 who received CBZ‐CR in the double‐blind trial (CBZ‐CR/ESL) were treated with ESL monotherapy (89.3% overall). Treatment retention time was similar between groups, with low probability of ESL withdrawal overall (<0.07 at any time). After 24 months, the probability of ESL withdrawal was 0.0638 (95% confidence interval [CI] = 0.0292‐0.1366) in the ESL/ESL group and 0.0472 (95% CI = 0.0180‐0.1210) in the CBZ‐CR/ESL group. Seizure freedom rates were 90.6% (ESL/ESL) and 80.7% (CBZ‐CR/ESL; P = .0531). Responder rates remained >80% in both groups throughout the study. Incidence of serious TEAEs was similar between groups (7.3% vs 5.7%; 0% vs 1.1% possibly related), as were the incidences of TEAEs considered at least possibly related to treatment (17.7% vs 18.2%) and TEAEs leading to discontinuation (3.1% vs 4.5%). The types of TEAEs were generally consistent with the known safety profile of ESL.

Significance

ESL monotherapy was efficacious and generally well tolerated over the long term, including in patients who transitioned from CBZ‐CR monotherapy. No new safety concerns emerged.