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Overnight switch from carbamazepine to eslicarbazepine in a real-life clinical scenario: a retrospective study

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Abstract

Background

Carbamazepine (CBZ) is a first-choice anti-seizure medication (ASM) whose efficacy is often invalidated by adverse effects (AEs). Eslicarbazepine (ESL) is a structural derivative of CBZ with better pharmacokinetic/tolerability profiles. We describe our experience of the overnight CBZ to ESL switch in people with epilepsy (PwE) to improve seizure control, AEs, and ASMs adherence.

Methods

We retrospectively included 19 PwE (12 females, 53 ± 21 years old) who underwent CBZ to ESL overnight switch due to single/multiple issues: poor efficacy (pEff, N = 8, 42%), tolerability (pToll, N = 11, 58%), adherence (pAdh, N = 2, 10%). 9/19 (47%) had psychiatric comorbidities. Clinical variables, seizure frequency, and AEs were recorded at switch time (T0) after 3.5 ± 3 (T1) and 6.5 ± 1.5 months (T2).

Results

At T1, in pEff group, 1/8 (13%) was seizure free, 2/8 (25%) were responders (> 50% seizure reduction), 2/8 (25%) had no seizure changes, 3/8 (37%) had seizure worsening; the latter were those with the most severe epilepsy and encephalopathy. In pToll group, all PwE experienced AEs disappearance/amelioration. In pAdh group, all PwE reported adherence amelioration. Four dropouts. At T2, no changes were recorded within groups, while in the whole sample, 6/15 (40%) were responders, and 4/15 (27%) were seizure-free. No one complained of Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation psychiatric worsening, while 6/19 (32%) experienced mood/behavior benefits.

Conclusions

CBZ to ESL overnight switch offers an opportunity to improve efficacy, tolerability, adherence, and psychiatric symptoms.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, G.A., upon reasonable request.

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Authors and Affiliations

  1. UOC Neurologia, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Biagio Maria Sancetta, Lorenzo Ricci, Flavia Narducci, Giulia Lippa, Marianna Nesta, Vincenzo Di Lazzaro, Mario Tombini & Giovanni Assenza

  2. Research Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy

    Biagio Maria Sancetta, Lorenzo Ricci, Flavia Narducci, Giulia Lippa, Marianna Nesta, Vincenzo Di Lazzaro, Mario Tombini & Giovanni Assenza

  3. Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of the Milano Institute, Milan, Italy

    Jacopo Lanzone & Marilisa Boscarino

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  1. Biagio Maria Sancetta
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  2. Lorenzo Ricci
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Contributions

Conceptualization: BMS and AG; methodology: AG, LR, and SBM; validation: TM, RL, DLV, VC, BM, NF, LC, LJ, MP, and MNB; formal analysis: GA, RL, and SBM; investigation: AG and MP; resources: AG; data curation: GA and SBM; writing—original draft preparation: AG; writing—review and editing: AG and SBM; visualization: AG; supervision: AG; project administration: AG. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Biagio Maria Sancetta.

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Written informed consent has been obtained from the patients.

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Sancetta, B.M., Ricci, L., Lanzone, J. et al. Overnight switch from carbamazepine to eslicarbazepine in a real-life clinical scenario: a retrospective study. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07354-6

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