Lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes
Tohru Okanishi1, Yuji Fujii2, Satoru Sakuma3
1Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan; Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital Hamamatsu, Japan.
Insights
Lacosamide monotherapy effectively controlled seizures in 83% of children with centrotemporal spikes epilepsy, with most achieving freedom within 4 months. This antiepileptic drug demonstrated good efficacy and few side effects.
Area of Science:
- Pediatric Neurology
- Epileptology
- Clinical Pharmacology
Background:
- Childhood epilepsy with centrotemporal spikes (CECTS) is a common, age-limited focal epilepsy syndrome in children.
- Effective antiepileptic drug (AED) options are crucial for managing CECTS and improving patient outcomes.
- Lacosamide, a third-generation AED, has shown promise in various epilepsy types.
Purpose of the Study:
- To evaluate the efficacy of lacosamide monotherapy in treating new-onset Childhood epilepsy with centrotemporal spikes (CECTS).
- To assess seizure control rates and the time to achieve seizure freedom.
- To document adverse effects associated with lacosamide treatment in this pediatric population.
Main Methods:
- Retrospective analysis of 18 pediatric patients (3-13 years) diagnosed with CECTS.
- Inclusion criteria: specific seizure types, EEG findings, no intellectual disability, and ≥6 months of lacosamide monotherapy.
- Seizure frequency and freedom evaluated at 0-3, 4-6, and 7-12 months post-initiation and during the last 6 months of follow-up.
Main Results:
- Seizure freedom rates were 39% (0-3 months), 67% (4-6 months), and 72% (7-12 months).
- Overall, 83% of patients achieved seizure freedom, with 72% becoming seizure-free within the first 4 months.
- Lacosamide was well-tolerated, with only four patients experiencing transient fatigue or somnolence.
Conclusions:
- Lacosamide monotherapy demonstrated significant efficacy in controlling seizures in children with CECTS.
- The drug was associated with a favorable safety profile, showing few and transient adverse effects.
- Lacosamide presents a promising option as a potential first-line treatment for new-onset CECTS.
Objective:
Childhood epilepsy with centrotemporal spikes (CECTS) is known as age-limited focal epilepsy syndrome in childhood. Lacosamide is a third-generation antiepileptic drug. This study aimed to evaluate the efficacy of lacosamide monotherapy for the treatment of CECTS.
Methods:
We enrolled 18 patients (6 girls and 12 boys) who met the following criteria: 1) the age of onset of the seizures was between 3 and 13 years of age; 2) showing at least hemifacial and/or oropharyngeal seizures; 3) interictal discharges in central and/or middle temporal electrodes; 4) no intellectual disability; 5) treatment duration of lacosamide monotherapy over 6 months. We retrospectively collected and analyzed clinical data and treatment information. We evaluated the seizure occurrences during 0-3, 4-6, and 7-12 months from the treatment initiation and the last 6 months of the follow-up. We also evaluated the outcomes as seizure-free if the patients developed no seizures both over 6 months and 3 times of pretreatment mean seizure interval at the last follow-up.
Results:
Of the patients, 39%, 67% and 72% were seizure-free during 0-3, 4-6, and 7-12 months from treatment initiation, respectively. Finally, 83% of the patients achieved seizure freedom. Seizure freedom was achieved in 72% during the first 4 months of treatment. All patients continued lacosamide monotherapy during the study, although four patients showed transient fatigue or somnolence.
Conclusions:
Lacosamide showed good efficacy for controlling seizures with fewer adverse effects, and therefore may be a good candidate as a first-line medication for the treatment of new-onset CECTS.
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