The Safety and Efficacy of Adjunctive Lacosamide for Partial‐Onset Seizures: A Meta‐Analysis

ABSTRACT Background Nearly one‐third of patients with epilepsy fail to achieve seizure remission despite appropriate anti‐seizure medications. Lacosamide has emerged as a potential adjunctive therapy for drug‐resistant partial‐onset seizures. Objective To evaluate the efficacy and safety of adjunctive lacosamide in patients with partial‐onset seizures. Methods PubMed, Embase, and Cochrane databases were searched for randomized controlled trials evaluating adjunctive lacosamide. Efficacy outcomes included ≥ 50% and ≥ 75% reductions in seizure frequency. Safety outcomes included treatment‐emergent adverse events (TEAEs) and discontinuation due to TEAEs. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using the Mantel–Haenszel method. Heterogeneity was assessed with the I 2 statistic, and risk of bias was evaluated using the Cochrane RoB 2 tool. Results Of 3273 records identified, seven RCTs met inclusion criteria. Adjunctive lacosamide significantly increased the likelihood of achieving a ≥ 50% reduction in seizure frequency (RR 1.72, 95% CI 1.45–2.05; p < 0.00001; I 2 = 37%) and a ≥ 75% reduction (RR 2.01, 95% CI 1.57–2.57; p < 0.00001; I 2 = 0%). Lacosamide was associated with a non‐significant increase in TEAEs (RR 1.06, 95% CI 0.99–1.15; p = 0.09; I 2 = 42%) but a significant increase in discontinuations due to TEAEs (RR 1.83, 95% CI 1.23–2.71; p = 0.003; I 2 = 26%). Most studies were judged to have a low risk of bias. Conclusion Adjunctive lacosamide improves seizure control in patients with drug‐resistant partial‐onset seizures. However, its increased risk of treatment discontinuation should be considered when selecting therapy.