A patient asks you to prescribe Lacosamid for prevention of his migraine. She seems to have discovered by chance (when she was given Lacosamid for presumed seizures which then turned out to be syncopes) that her migraines – gravely discomforting her for up to 2 days a week – improved on Lacosamid, getting milder if not disappearing totally.
How do you substantiate her claim of benefit? How do you convince her HMO to pay for it?
The answer – as usual – lies in EBM. We discuss the n-of-1 trial, the statistics and the ethical dimensions, using the following resources:
- The n-of-1-study. Personalized Medicine 2011.
- Sackett et al. The User’s guide to the Medical Literature