Lacosamide augments topiramate's efficacy in epilepsy by modulating HMGB1/FGL2 pathways

Abstract:Objective To compare lacosamide-topiramate combination vs topiramate monotherapy in epilepsy and its impact on serum HMGB1、FGL2 levels. Methods The clinical data of 120 epilepsy patients admitted to the Department of Neurology of Xuanwu Hospital, Capital Medical University from January 2023 to January 2025 were retrospectively selected. According to the medication situation of the patients, they were divided into 2 groups. Patients treated with topiramate alone were the monotherapy group(n=58), and patients treated with topiramate combined with lacosamide were the combination group(n=62).The clinical efficacy, epileptic seizure conditions, cognitive function, electroencephalogram, and changes in serum HMGB1 and FGL2 levels were compared between the two groups. Results The total effective rate of the combined group was 91.94%, which was higher than that of the single-drug group(77.59%)(χ²/P=4.839/0.028). After 6 months of treatment, the frequency of epileptic seizures in the combination group was less than that in the single-drug group, and the duration of seizures was shorter than that in the single-drug group(t/P=12.247/<0.001, 8.608/<0.001).The scores of the Mini-Mental State Examination(MMSE) and the Montreal Cognitive Assessment(MoCA) in the combined group were higher than those in the single-drug group(t/P=5.650/<0.001, 4.988/<0.001). The collaboration group had higher powers of α and β bands than the topiramate group, and lower powers of δ and θ bands than the topiramate group(t/P=3.366/0.001, 3.922/<0.001, 3.235/0.002, 3.152/0.002). The collaboration group had lower serum HMGB1 and FGL2 than the topiramate group(t/P=2.160/0.033, 2.945/0.004).Conclusion Lacosamide synergizes with topiramate to enhance seizure control and neuroprotection.