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Efficacy of lacosamide as adjunctive therapy in children with refractory epilepsy
William R Yorns1, Divya S Khurana, Karen S Carvalho
11Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA.
Insights
Lacosamide, an FDA-approved antiepileptic drug, shows efficacy and good tolerability in children with refractory epilepsy. Over 40% of pediatric patients experienced significant seizure reduction, with some becoming seizure-free.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Lacosamide is an FDA-approved antiepileptic drug (AED) for adults with partial epilepsy.
- Limited data exist regarding lacosamide's use in pediatric populations.
- Refractory epilepsy in children poses significant treatment challenges.
Purpose of the Study:
- To evaluate the efficacy and safety of lacosamide in children with refractory epilepsy.
- To assess seizure frequency reduction and adverse events in pediatric patients treated with lacosamide.
Main Methods:
- Retrospective chart review of 40 children (mean age 14.3 years) with refractory epilepsy treated with lacosamide.
- Lacosamide was administered as adjunctive therapy in 36 patients and monotherapy in 4.
- Patient epilepsy types included focal (symptomatic/cryptogenic) and generalized (symptomatic/cryptogenic) epilepsy, juvenile myoclonic epilepsy, and Lennox-Gastaut syndrome.
Main Results:
- 42% of patients achieved at least a 50% reduction in seizure frequency.
- 6 patients (15%) became seizure-free.
- The average reduction in seizure frequency for responders was 76.5%.
- 15 children experienced adverse reactions, with 7 discontinuing the drug due to ineffectiveness, insurance denial, or side effects (tremor, behavior).
Conclusions:
- Lacosamide is an effective and well-tolerated treatment option for children with refractory epilepsy.
- The study supports the use of lacosamide in pediatric patients, demonstrating significant seizure control.
- Further prospective studies are warranted to confirm these findings in larger pediatric cohorts.
Abstract:
Lacosamide is a US Food and Drug Administration (FDA)-approved antiepileptic drug for patients 17 years or older with partial epilepsy. There are sparse data on children. The objective of our study was to evaluate its efficacy/safety in children with refractory epilepsy. Forty children (mean age 14.3 years) were treated with lacosamide at our institution (adjunctive therapy in 36, monotherapy in 4). Fifteen patients had symptomatic focal epilepsy, 2 had cryptogenic focal epilepsy, 20 had symptomatic generalized epilepsy, and 3 had cryptogenic generalized epilepsy. Two had juvenile myoclonic epilepsy and 5 had Lennox-Gastaut syndrome. Forty-two percent had at least >50% reduction in seizure frequency, and 6 became seizure free. Average dose was 7 mg/kg/d and average follow-up was 9.2 months. Responders had a 76.5% mean decrease in seizures. Fifteen children experienced an adverse reaction and 7 discontinued lacosamide (4: Ineffective, I: insurance denial, 1: tremor, 1: behavior). Lacosamide is effective and well-tolerated in children with refractory epilepsy.
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