Abstract：
Carbamazepine (CBZ) use has been limited by multiple adverse reactions. Lacosamide (LCM) is a functional amino acid anti-seizure medication (ASM), approved for focal seizure patients more than 4 years old. It is non-inferior in terms of efficacy to controlled release CBZ and was proven to have better tolerability. This study examines the effect of abruptly changing CBZ to LCM in epilepsy patients with elevated gamma-glutamyl transpeptidase (GGT). Consenting adult patients aged 18 years old and above, with controlled focal seizure disorder for more than 2 years, who were consistently taking CBZ and who had elevated GGT were included in this study. Out of 1526 patients screened, only 12 satisfied the inclusion criteria. After abruptly changing CBZ to LCM, the GGT level significantly dropped from a median of 141.5 to 63.5 IU/L (z = 3.06, p = 0.0005). Moreover, there was significantly lower proportion of patients with abnormal GGT levels after the switch in medications was done (100% vs. 66.7%, McNemar χ2 = 8, p = 0.008). Moderate to high levels of GGT in patients with focal epilepsy can be decreased by changing CBZ to LCM. Moreover, abruptly changing CBZ to LCM without cross-titration may be safe and effective in preventing seizure incidence within a 1-month period. PLAIN LANGUAGE SUMMARY: Although carbamazepine (CBZ) is the standard drug for focal seizures, its numerous side effects, especially in the liver, limits its use in a lot of patients with epilepsy. Gamma-glutamyl transferase (GGT), which is elevated in liver disease of whatever cause including intake of CBZ, is associated with increased mortality. In this study, we found that abruptly changing CBZ to Lacosamide (LCM) can significantly decrease the GGT level in 1 month without apparent increase in seizure recurrence and side effects. Therefore, we conclude that high levels of GGT may be decreased by abruptly changing CBZ to LCM.
摘要：
卡马西平（CBZ）的使用受到多种不良反应的限制。Lacosamide（LCM）是一种功能性氨基酸抗癫痫药物（ASM），批准用于4岁以上的局灶性癫痫患者。就疗效而言，它与控释CBZ不差，并被证明具有更好的耐受性。这项研究研究了在γ-谷氨酰转肽酶（GGT）升高的癫痫患者中突然将CBZ更改为LCM的作用。同意18岁及以上的成年患者，局灶性癫痫发作控制超过2年，持续服用CBZ和GGT升高的患者被纳入本研究.在筛查的1526名患者中，只有12人符合纳入标准。突然将CBZ更改为LCM后，GGT水平从中位数141.5显著下降至63.5IU/L(z=3.06,p=0.0005).此外，更换药物后，GGT水平异常的患者比例明显较低(100%vs.66.7%,McNemarχ2=8，p=0.008）。通过将CBZ更改为LCM，可以降低局灶性癫痫患者的中度至高水平的GGT。此外，在不进行交叉滴定的情况下突然将CBZ更改为LCM可能是安全有效的,可在1个月内预防癫痫发作.尽管卡马西平（CBZ）是局灶性癫痫发作的标准药物，它的许多副作用，尤其是在肝脏，限制了它在很多癫痫患者中的使用。γ-谷氨酰转移酶（GGT），无论什么原因，包括摄入CBZ，肝病都会升高，与死亡率增加有关。在这项研究中,我们发现,将CBZ突变为Lacosamide(LCM)可在1个月内显著降低GGT水平,而不会明显增加癫痫发作的复发和副作用.因此,我们得出的结论是，突然将CBZ改为LCM可能会降低高水平的GGT。
