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Lacosamide in children with refractory status epilepticus. A multicenter Italian experience
Salvatore Grosso1, Nelia Zamponi2, Arnaldo Bartocci3
1Pediatric Neurology-Immunology and Endocrinology Unit, University of Siena, Italy; Department of Pediatrics, University of Siena, Italy.
Insights
Intravenous lacosamide (LCM) may effectively treat refractory status epilepticus (RSE) in children when standard antiepileptic drugs fail. This study found LCM to be well-tolerated, offering a potential new option for this critical condition.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Pharmacology
Background:
- Status epilepticus (SE) is a critical neurological emergency requiring prompt treatment.
- Refractory status epilepticus (RSE) occurs when initial antiepileptic drugs (AEDs) are ineffective.
- Limited evidence exists for RSE management guidelines in pediatric populations.
Purpose of the Study:
- To evaluate the efficacy and tolerability of intravenous lacosamide (iv LCM) in pediatric patients with RSE.
- To assess LCM as a treatment option for RSE unresponsive to standard therapies.
Main Methods:
- A study cohort included children diagnosed with RSE treated with iv LCM.
- Efficacy was determined by complete seizure cessation post-LCM administration without additional AEDs.
- Patients had previously failed standard RSE treatment protocols.
Main Results:
- Eleven children (mean age 9.4 years) with RSE were analyzed.
- Intravenous lacosamide, used as a fourth-line or later treatment, effectively stopped seizures in 45% of patients.
- No serious adverse events related to LCM were reported during the study.
Conclusions:
- Intravenous lacosamide demonstrates potential as an effective and well-tolerated AED for pediatric RSE.
- LCM offers a promising therapeutic option for children with refractory seizures.
Objective:
Status epilepticus (SE) is considered a life-threatening medical emergency. First-line treatment with antiepileptic drugs (AEDs) consists of intravenous benzodiazepines followed by phenytoin. SE is considered refractory (RSE) when unresponsive to standard doses of the first two AEDs. Scarce evidence is available to support specific guidelines for the management of RSE in either adults or children. This study aimed to assess the efficacy and tolerability of intravenous (iv) lacosamide (LCM) in children affected by RSE.
Method:
Children with RSE who were treated with ivLCM were included in the study. Efficacy was defined as the cessation of seizures after administration of ivLCM, with no need for any further antiepileptic drug. All patients had been unsuccessfully treated following standard protocols before ivLCM was administered.
Results:
Eleven children entered the study (mean age: 9.4 years). Etiology was symptomatic in 7 patients (63%). RSE was convulsive (focal or generalized) in 6 patients and nonconvulsive in 5. The mean initial bolus dose of LCM was 8.6 mg/kg. The drug, which was used as a fourth or later option, was effective in stopping RSE in 45% of patients, with seizures terminating within 12 h in three children. No serious adverse events attributable to LCM were reported.
Conclusions:
LCM might be an effective and well-tolerated AED in children with RSE.
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