Real-world use of lacosamide in epilepsy: results from a cross-sectional survey of neurologists in India

Background: Epilepsy affects over 50 million people worldwide, having significant burden in countries like India. Despite existing antiepileptic drugs (AEDs), many patients face suboptimal seizure control or side effects. This survey aimed to assess how Indian neurologists use lacosamide in routine epilepsy care. Methods: A cross-sectional, questionnaire-based survey was conducted across India between January and March 2025, involving 244 neurologists actively managing epilepsy cases. The 20-item survey questionnaire covered clinical scenarios for lacosamide use, dosing and titration strategies, efficacy perceptions, safety practices, drug-drug interactions, application in special populations, intravenous use, and patient adherence. Responses were collected anonymously and analyzed descriptively. Results: This survey of Indian neurologists reveals widespread use of lacosamide, primarily for focal-onset seizures in both refractory (55.3%) and newly diagnosed (49.6%) cases. It is mostly used as adjunctive therapy (70.5%), with some using it as monotherapy according to patient needs. Safety and tolerability (63.1%) are the primary drivers for prescribing lacosamide, with efficacy (42.6%) as a key secondary factor. Seizure control is often achieved within 2–4 weeks (49.2%) and its use in pediatric and elderly patients is selective, with lower starting doses. Overall, 92.6% of neurologists reported satisfaction with lacosamide in clinical practices. Conclusions: The findings highlight lacosamide as a well-accepted and widely utilized antiepileptic drug among Indian neurologists, valued for its safety, tolerability, and efficacy. Its flexible use across diverse patients, especially in focal-onset seizures, combined with high clinician satisfaction, reinforces its role as a trusting option in real-world epilepsy management.