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Effectiveness and tolerability of lacosamide in children with drug resistant epilepsy
J T Driessen1,2, E A Wammes-van der Heijden1,3, P Verschuure4
1Department of Research and Development, Epilepsy Centre Kempenhaeghe, Post address: Sterkselseweg 65, 5591 VE Heeze, The Netherlands.
Insights
Lacosamide (LCM) effectively treats drug-resistant epilepsy in children, showing good retention and response rates over two years. While side effects like somnolence occurred, LCM is a viable option for pediatric epilepsy management.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Epilepsy affects millions of children globally, with a significant portion experiencing drug-resistant forms.
- Effective and tolerable anti-seizure medications (ASMs) are crucial for managing pediatric epilepsy.
Purpose of the Study:
- To evaluate the efficacy and tolerability of lacosamide (LCM) in children with drug-resistant epilepsy.
- To determine retention rates, effectiveness, reasons for discontinuation, and side-effect profiles of LCM.
- To identify prognostic variables associated with LCM discontinuation and side-effect incidence.
Main Methods:
- Retrospective study of 79 children (<18 years) with drug-resistant epilepsy treated with LCM.
- Data collected from 2013-2019 at a tertiary care center, with a two-year follow-up.
- Analysis of retention rates, effectiveness, reasons for termination, side-effects, and prognostic factors.
Main Results:
- LCM retention rates were 89.9% at 3 months, 68.4% at 12 months, and 54.4% at 24 months.
- Effective response rates among continuing users were 60.5% (3m), 67.9% (12m), and 71.4% (24m).
- Lack of efficacy (58.3%) was the primary discontinuation reason. Common side effects included somnolence (18.2%), behavioral changes (15.6%), headache, and dizziness. Concomitant use of sodium channel blockers increased side-effect risk (OR=4.038).
Conclusions:
- Lacosamide demonstrates significant efficacy and acceptable tolerability in children with drug-resistant epilepsy.
- LCM offers a valuable treatment option, though careful monitoring for side effects is warranted.
- Prognostic factors like concurrent sodium channel blocker use and number of ASMs influence LCM outcomes.
Abstract:
We retrospectively studied the efficacy and tolerability of lacosamide (LCM) in children with drug-resistant epilepsy in a tertiary care centre in the Netherlands, from 2013 till 2019, with a follow-up of two years. 79 children, aged < 18 years, were included. Retention rate, effectiveness, reason for termination, and side-effects were analysed. Furthermore, prognostic variables for discontinuation as well as the incidence of side-effects were determined. The LCM retention rate and effectiveness of response were analysed at three, twelve and twenty-four months. The retention rate of LCM was respectively 89.9 %, 68.4 % and 54.4 %. LCM gave an effective response in 60.5 %, 67.9 % and 71.4 % of the participants who were still using LCM at the three follow-up periods. Lack of efficacy was most frequently reported as a reason for discontinuation (58.3 %). Side-effects occurred in 50.6 % of the patients, somnolence (18.2 %) being the most common, followed by behavioural changes (15.6 %), headache (9.1 %) and dizziness (9.1 %). Use of ≥ 1 sodium channel blocker (SCB) was associated with an increased risk (OR = 4.038) of side-effects. An increasing number of anti-seizure medications (ASM) was associated with a reduced risk (OR = 0.524) of stopping LCM. To conclude, LCM is an effective ASM with acceptable side-effects in children with drug-resistant epilepsy.
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