The verdict on lacosamide (Vimpat®) as add on therapy for the treatment of partial onset seizures from the Midlands Therapeutics Review and Advisory Committee (MTRAC) is that it should be initiated and stabilised within secondary care, after which it is then appropriate for GPs to prescribe this treatment over the longer term. As there are a number of established therapies for use in this setting, lacosamide is considered to have a relatively low place in therapy. The Committee noted that the evidence for efficacy was relatively strong, based on 3 RCTs comparing lacosmide with placebo. These showed that compared with placebo, treatment with 400mg lacosamide was associated with a greater decrease in seizure frequency, and a higher proportion of patients experiencing at least a 50% decrease in seizure frequency. Evidence for the 200mg dose was weaker.