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Purpose: Lacosamide (LCM), the R-enantiomer of 2-acetamido-N-benzyl-3-methoxypropionamide, is a newer approved antiseizure medication characterized by a novel pharmacodynamic and favorable pharmacokinetic profile that was approved as adjunctive treatment for adults with focal onset and focal to bilateral tonic-clonic seizures in 2008, and recently also for monotherapy. The aim of this study was to evaluate the effectiveness and tolerability of LCM as first add-on or conversion monotherapy in adult subjects with focal epilepsy., Methods: We retrospectively included all adult patients who received LCM as first add-on regimen or as substitution monotherapy at least 12 months before starting the chart review, with a historical baseline of 6 months prior to day of the first administration of LCM. The choice of treatment was made independently by the epilepstologists, according to routine clinical practice. Clinical data were obtained at 3, 6, and 12 months after subjects started LCM and then analyzed to assess retention rate, seizure freedom, and adverse events (AE)., Results: A total of 101 patients (58 men) with a mean age of 44 years and a median epilepsy duration of 6.6 years (range 1-53) were included in the study. At 12 months 72 patients retained LCM, 54 (75%) of them were seizure free, 44 (81.5%) in monotherapy and 10 (18.5%) in add-on LCM treatment. Among all subjects, 31 (57.4%) were free from seizure under LCM monotherapy throughout the entire observation period. Thirty one out of 72 (43%) PwE who retained LCM at 12 months, were free from seizures throughout the entire observation period. The maintenance median dosage of LCM was 200 mg/day. Ten (10%) subjects reported mild to moderate AE, most commonly drowsiness and dizziness. No serious AE were documented., Conclusions: This real-life study confirms that LCM is an effective and well tolerated treatment option as first add-on or conversion monotherapy for focal seizures., Competing Interests: Declaration of Competing Interest Sara Casciato has participated in pharmaceutical industry-sponsored symposia for Eisai, UCB Pharma and Lusofarmaco. Alfredo D’Aniello has participated in pharmaceutical industry-sponsored clinical-trials for UCB Pharma and symposia for Eisai, UCB Pharma and Lusofarmaco. Giancarlo Di Gennaro has participated in advisory boards and pharmaceutical industry-sponsored symposia for Eisai, UCB Pharma, Bial, Lusofarmaco, Livanova and Arvelle. Pier Paolo Quarato has participated in pharmaceutical industry-sponsored clinical-trials and symposia for UCB Pharma. Alessandro Gialluisi was supported by Fondazione Umberto Veronesi., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to report long-term seizure outcome in patients who underwent frontal lobe epilepsy (FLE) surgery., Method: This retrospective study included 44 consecutive subjects who underwent resective surgery for intractable FLE at IRCCS NEUROMED (period 2001-2014), followed up for at least 2 years (mean: 8.7 years). All patients underwent noninvasive presurgical evaluation and/or invasive electroencephalography (EEG) monitoring when nonconcordant data were obtained or epileptogenic zone was hypothesized to be close to the eloquent cortex. Electroclinical, neuroimaging, surgical data, and histology were compared to seizure outcome., Results: Mean epilepsy duration was 19 years; mean age at surgery was 31.6 years. Preoperative magnetic resonance imaging (MRI) showed a frontal lesion in 86.4 % of cases. Scalp video-electroencephalography (VEEG) monitoring detected a focal ictal onset in 90% of cases. Twenty-seven patients (61.4%) underwent invasive recordings. Resections involved dorsolateral (47.7%), medial (9%), orbital (13.6%), and rolandic (13.6%) region. Lobectomy within functional boundaries was performed in the remaining 7 cases (16%). Transient and permanent neurological deficits were observed in 2 and 3 cases, respectively. Histology revealed focal cortical dysplasia (45.5%), World Health Organization (WHO) I-II grade tumors (15.9%), gliosis (22.7%), vascular malformations (4.5%), Rasmussen encephalitis (6.8%), and normal tissue (4.5%). At last observation 68.1% of patients were in Engel's class I, 11.4% in class II, 9% in class III, and 11.4% in class IV. A favorable outcome was associated with focal ictal scalp EEG onset (p = 0.0357)., Conclusion: Surgery is a safe treatment option in drug-resistant FLE with a satisfying long-term outcome. These data highlight the importance of an appropriate selection of potential surgical candidates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We investigated different aspects of facial expression evaluation in a homogeneous cohort of 42 seizure-free patients with 5 or more years of follow-up after temporal lobectomy (TL), with the aim of further characterizing the impairment in emotion and social cognition among patients. A group of healthy subjects matched for sex, age, and education served as controls. Four tasks of facial expression evaluation were used: (a) facial expression recognition, (b) rating of the intensity of facial expression, and (c) rating of valence (pleasantness) and (d) rating of arousal induced by facial expressions. Patients had a worse performance in the recognition task for all negative emotions, while no differences in intensity ratings were found. They also reported lower arousal ratings than controls for faces showing fear, anger, disgust, and neutral expressions, as well as lower valence ratings for all facial expressions except those showing happiness. Longer epilepsy duration before TL was negatively associated with ratings of arousal and intensity and positively associated with valence ratings for fearful facial expressions. This study showed that patients who become seizure-free after TL present long-term deficits in several aspects of facial expression evaluation. Longitudinal, prospective studies are needed to evaluate if social cognition improves or declines after TL., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Learning and memory of declarative knowledge and relational information are dependent on the integrity of medial temporal lobe (MTL). Numerous studies suggest that left lobectomy impairs verbal memory while right lobectomy impairs non-verbal memory. In order to instrumentally quantify material-specific memory impairment after temporal lobe excision, we compared, using a computerized conditional motor associative learning task, patients with surgically treated drug-resistant temporal lobe epilepsy to age-matched controls. We enrolled seven epileptic patients with left (LTR), seven with right (RTR) temporal lobe resection and fourteen controls. During the task, abstract visual stimuli had to be associated, by trial and error, with a spatially oriented joystick motor response. Response and decision time were analyzed. Statistical analysis disclosed that the learning curve slopes of both RTR and LTR patients were significantly shallower compared to controls, LTR patients needed a number of test trials significantly increased compared to RTR patients and controls, the average probability of success in the test trials was significantly lower in LTR patients compared to RTR patients and controls, and RTR patients' decision times were significantly longer than LTR patients and controls. The results suggest that RTR patients, using the preserved verbalization strategy, achieved higher learning scores than LTR patients, which were forced to use a visuo-spatial representation of the stimuli-response association. Accordingly, RTR patients were significantly slower, compared to LTR patients and controls, indicating that processes involving recall were partially impaired, and non-canonical networks for executing a non-verbal task could be in action., (Copyright © 2011 Elsevier Inc. All rights reserved.)