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(S)-lacosamide is a small molecule drug that is an inactive analog of the clinically approved anti-epileptic drug (R)-Lacosamide (Vimpat®). Despite being an inactive analog of (R)-Lacosamide, (S)-lacosamide exhibits a distinct mechanism of action relevant to migraine treatment. It inhibits the phosphorylation of collapsin response mediator protein 2 (CRMP2) by cyclin dependent kinase 5 (Cdk5) in sensory neurons. This action leads to a decrease in depolarization-evoked Ca2+ influx and subsequently blocks the release of calcitonin gene related peptide (CGRP) from dural nerve terminals. (S)-lacosamide has shown potential as a therapy for acute migraine by inhibiting cutaneous allodynia in animal models.
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