Original ArticleExperience With Lacosamide in a Series of Children With Drug-Resistant Focal Epilepsy
Introduction
Lacosamide is a new antiepileptic drug (AED) approved by the US Food and Drug Administration for adjunctive therapy in focal epilepsy in patients more than 17 years old [1]. Because of its novel mode of action of selective enhancement of the slow inactivation of voltage-gated sodium channels [2], [3], it may be specifically helpful in patients who have not responded to other AEDs. There have been 1 phase II [4] and 2 phase III clinical trials with lacosamide [5], [6] that demonstrated good efficacy and tolerability for treatment of focal epilepsy in subjects more than 16 years old. Some reports also provided additional indications in status epilepticus [7], [8], with controlled studies revealing a similar safety and tolerability profile of the intravenous formulation to oral lacosamide [9], [10].
Lacosamide has been demonstrated to have a fast onset of anticonvulsant activity and to greatly reduce focal seizures at doses of 200 to 400 mg daily as adjunct therapy in drug-resistant focal epilepsy in adults [4], [5], [6], [11]. The most common adverse effect was dizziness, which was dose related and observed more in the titration period. Other effects included coordination abnormalities, vomiting, diplopia, nausea, vertigo, and blurred vision [4], [5], [6], [11]. Baseline electrocardiogram was necessary because of selective dose-dependent reversible enhancement of slow inactivation of cardiac sodium channels inducing dose-dependent prolongation of the PR interval [2], [3], [12].
We report the experience with the use of oral lacosamide in children with drug-resistant focal epilepsy at a tertiary-care center, Children’s Hospital Boston.
Section snippets
Patients and Methods
We performed a 2-year retrospective analysis (July 2008 to June 2010) of the electronic charts of the neurology outpatient and inpatient database and reviewed clinical presentation as well as outcome of children receiving lacosamide. The inclusion criteria were use of lacosamide, age up to 21 years, focal epilepsy, and assessment in the Department of Neurology, Children’s Hospital Boston. The exclusion criterion was lack of follow-up visit.
Epileptic seizures were classified according to the
Results
We identified 24 patients who received oral lacosamide. Eight patients were excluded from analysis (3 older than 21 years, 4 with inadequate clinical information, and 1 with primary generalized epilepsy).
Summary
This retrospective study of 16 children (mean age 14.9 years) with drug-resistant focal epilepsy revealed adjunctive lacosamide administration to have good efficacy (median seizure reduction of 39.6% and 37.5% [6/16] with ≥50% seizure reduction) without severe adverse events; 25% (4/16) had unacceptable adverse events, including a patient who manifested depression and suicidal ideation.
Previous Studies
Previous studies have reported lacosamide use in patients more than 16 years old. The median age of our
Conclusion
In this series of 16 children with treatment drug-resistant focal epilepsy and with a mean age of 14.9 years (range 8-21 years) and a median follow-up of 4 months, lacosamide administration led to a median seizure reduction of 39.6%, with 37.5% of the patients demonstrating a ≥50% reduction in seizure frequency and no severe adverse events observed. A prospective multicenter study in children is needed to validate our observations.
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2020, Life SciencesCitation Excerpt :However, still, none of them has proved to be successful in thoroughly controlling the seizures in drug-resistant epilepsy. Besides, it is suggested that data on the efficacy of LCM in clinical practice are still insufficient [33] and, the access of LCM into the brain parenchyma is restricted owing to the functioning BBB, which may limit the anticonvulsant and/or antiepileptogenic actions of the drug [24,25,34]. A recent study reported common side effects, including dizziness, ataxia, nausea, and vomiting associated with the use of LCM in the treatment of childhood refractory focal epilepsy [34,35].