Intravenous lacosamide for pediatric status epilepticus and seizure clusters: A single-center observational study

To evaluate effectiveness and safety of intravenous lacosamide (IV LCM) in pediatric patients with status epilepticus (SE) and seizure clusters (SC) at a tertiary referral center.

Retrospective cohort study including patients aged 0-18 years treated with IV LCM for SE or SC at a tertiary pediatric hospital in Bogotá, Colombia, between 2018 and 2023. Effectiveness in SE was defined as seizure cessation without recurrence within 24 h; and in SC, as seizure freedom at 24 h. Secondary outcomes included electroencephalographic (EEG) response and safety. Kaplan-Meier analysis was used to estimate seizure recurrence. All analyses were descriptive and exploratory; no formal sample size calculation or adjustment for multiple comparisons was performed.

Eighty-one patients were included (SE 69 [85.2%], SC 12 [14.8%]; median age 11.1 years). In SE, seizure cessation occurred in 78.2% and 87% of responders remained seizure-free at 24 h. When IV LCM was used early as a second-line agent, seizure cessation was achieved in 91.6%. In SC, 75% achieved seizure freedom at 24 h. The global probability of seizure freedom at 24 h was 88.9% (95% CI 81.5-97.0). EEG improvement was observed in 96.4% of evaluated SE responders. No significant differences were found according to dose, etiology, or SE type. One adverse event (1.2%) was reported (asymptomatic sinus bradycardia). No significant hemodynamic or laboratory changes were noted.

IV lacosamide was associated with high rates of seizure cessation and a favorable safety profile in this single-center, retrospective pediatric cohort, particularly when used early.