Long-Term Safety and Efficacy of Lacosamide Combined with NOACs in Post-Stroke Epilepsy and Atrial Fibrillation: A Prospective Longitudinal Study

<b>Background and Aims:</b> Stroke is the leading cause of seizures and epilepsy in adults; however, current guidelines lack robust recommendations for treating post-stroke seizures (PSSs) and epilepsy (PSE). This study aims to demonstrate the long-term safety and efficacy of lacosamide combined with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with PSE and atrial fibrillation (AF). <b>Methods:</b> In this prospective longitudinal single-center study, 53 patients with concomitant PSE and AF, admitted between 2022 and 2023, received NOACs for AF management and lacosamide for seizure control. A control group of 53 patients with cardioembolic stroke, receiving NOACs (but without PSE), was matched by age, sex, and NIHSS scores to ensure comparability. <b>Results:</b> Over 24 months, 16 patients in the study group and 15 in the control group experienced new embolic events, with no significant difference between groups (<i>p</i> = 0.82). Seizure control improved significantly in the study group, with reduced frequency and severity. No severe adverse events from lacosamide were observed. <b>Conclusions:</b> The combination of NOACs and lacosamide is a safe and effective treatment for patients with AF and PSE and does not increase the risk of recurrent ischemic or hemorrhagic events. Further studies with larger sample sizes and longer follow-ups are needed to confirm these findings and optimize treatment protocols.