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Lacosamide efficacy in epileptic syndromes with continuous spike and waves during slow sleep (CSWS)
Salvatore Grosso1, Pasquale Parisi2, Lucio Giordano3
1Neurology-Immunology and Endocrinology Unit, University of Siena, Italy; Department of Pediatrics, University of Siena, Italy.
Insights
Lacosamide add-on therapy shows promise for treating children with continuous spikes-waves during sleep (CSWS) epilepsy, improving EEG and clinical outcomes in a majority of patients.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Neurophysiology
Background:
- Continuous spikes-waves during sleep (CSWS) encompasses a range of epileptic disorders with a shared EEG characteristic.
- Established therapeutic strategies for CSWS are limited.
- This study investigates lacosamide as an add-on therapy for pediatric CSWS.
Purpose of the Study:
- To evaluate the efficacy of lacosamide add-on therapy in children with CSWS.
- To assess the impact of lacosamide on EEG, behavior, and cognitive functions.
Main Methods:
- Eight children with drug-refractory CSWS were enrolled.
- 24-hour EEG recordings were conducted at 6-month intervals to calculate the spike-wave index (SWI).
- Neuropsychological assessments were performed before and after at least 12 months of lacosamide treatment.
Main Results:
- After 6 months, 75% of patients responded to lacosamide, with 37% showing normalized 24-hour EEGs.
- Over a minimum of 12 months, 62.5% of patients were considered responders, despite two cases of electroclinical relapse.
- Slight improvements in neuropsychological functions were observed in 25% of patients.
Conclusions:
- Lacosamide add-on therapy appears to be safe and effective for managing CSWS in children.
- Further research is warranted to confirm these findings and establish lacosamide's role in CSWS treatment.
- The study suggests a potential new therapeutic avenue for pediatric epilepsy syndromes characterized by CSWS.
Background:
Epileptic syndromes with continuous spikes-waves during sleep (CSWS) represent a wide spectrum of epileptic disorders having CSWS as a common EEG-feature. Defined therapeutic strategies are still lacking. We evaluated the efficacy of lacosamide add-on therapy on the EEG, behavior, and cognition in children with CSWS.
Material And Methods:
Eight children with CSWS refractory to other conventional antiepileptic drugs were included in the study. A 24-h EEG recording was performed at 6-month-interval in all patients. The spike-wave index (SWI) was obtained in each 24-h EEG recording. Neuropsychological data were obtained before lacosamide introduction and after a minimum of 12 months of therapy.
Results:
After a 6-month period of therapy, 75% of patients was defined as responder, 12.5% as partial responder and another 12.5% as non-responder. In particular, 24-h EEG normalized in 3 cases (37%). After a minimum of 12 months, 24-h EEG normalized in another patient while two patients showed electroclinical relapses. A total of 62.5% of patients was therefore defined as responder. Neuropsychological functions slightly improved in 25% of patients.
Conclusion:
Although further studies are needed to validate our observations, this study suggests that lacosamide add-on therapy may be safe and effective in children affected by CSWS.
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