Lacosamide Use After Traumatic Brain Injury: A Scoping Review

Lacosamide (LCM) is a newer antiepileptic drug that enhances slow inactivation of voltage-gated sodium channels and modulates collapsin response mediator protein-2, suggesting potential roles in seizure control and axonal protection after traumatic brain injury (TBI). However, its role in TBI remains unclear. This scoping review aimed to characterize preclinical and clinical research on LCM use in TBI, focusing on seizure prophylaxis, seizure treatment, and potential neuroprotective effects. A comprehensive search of MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index of Nursing and Allied Health (CINAHL), Web of Science, and ClinicalTrials.gov was conducted. Studies involving human patients or animal TBI models evaluating acute LCM use were included, and data were charted descriptively. Ten studies were included, comprising five preclinical and five clinical investigations. Preclinical studies evaluated seizure-related, electrophysiological, histological, inflammatory, and behavioral outcomes in experimental TBI models. Clinical studies included two randomized trials, two observational cohorts, and one case report involving patients with moderate to severe TBI. LCM was administered for seizure prophylaxis or treatment. Seizure-related and safety outcomes were reported across clinical studies, whereas neurological and functional outcomes were less consistently assessed. Overall, evidence supporting LCM use in acute TBI remains limited, with differences between preclinical and clinical outcome domains.