title: Experience with lacosamide in a series of children with drug-resistant focal epilepsy.
abstract: We report our pediatric experience with lacosamide, a new antiepileptic drug, approved by the US Food and Drug Administration as adjunctive therapy in focal epilepsy in patients more than 17 years old. We retrospectively reviewed charts for lacosamide use and seizure frequency outcome in patients with focal epilepsy (Wilcoxon signed rank test). Sixteen patients (7 boys) were identified (median dose 275 mg daily, 4.7 mg/kg daily; mean age 14.9 years, range 8-21 years). Patients were receiving a median of 2 antiepileptic drugs (interquartile range [IQR] 1.7-3) in addition to having undergone previous epilepsy surgery (n=3), vagus nerve stimulation (n=9), and ketogenic diet (n=3). Causes included structural (encephalomalacia and diffuse encephalitis, 1 each; stroke in 2) and genetic abnormalities (Aarskog and Rett syndromes, 1 each) or cause not known (n=10). Median seizure frequency at baseline was 57 per month (IQR 7-75), and after a median follow-up of 4 months (range 1-13 months) of receiving lacosamide, it was 12.5 per month (IQR 3-75), (P<0.01). Six patients (37.5%; 3 seizure free) were classified as having disease that responded to therapy (≥50% reduction seizure frequency) and 10 as having disease that did not respond to therapy (<50% in 3; increase in 1; unchanged in 6). Adverse events (tics, behavioral disturbance, seizure worsening, and depression with suicidal ideation in 1 patient each) prompted lacosamide discontinuation in 4/16 (25%). This retrospective study of 16 children with drug-resistant focal epilepsy demonstrated good response to adjunctive lacosamide therapy (median seizure reduction of 39.6%; 37.5% with ≥50% seizure reduction) without severe adverse events.
authors.affiliation: Department of Neurology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
authors.forename: Laura M F F
authors.initials: LM
authors.lastname: Guilhoto
authors.forename: Tobias
authors.initials: T
authors.lastname: Loddenkemper
authors.forename: Vasu D
authors.initials: VD
authors.lastname: Gooty
authors.forename: Alexander
authors.initials: A
authors.lastname: Rotenberg
authors.forename: Masanori
authors.initials: M
authors.lastname: Takeoka
authors.forename: Frank H
authors.initials: FH
authors.lastname: Duffy
authors.forename: David
authors.initials: D
authors.lastname: Coulter
authors.forename: David
authors.initials: D
authors.lastname: Urion
authors.forename: Blaise F
authors.initials: BF
authors.lastname: Bourgeois
authors.forename: Sanjeev V
authors.initials: SV
authors.lastname: Kothare
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D004351:Drug Resistance / Q000502:physiology; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000078334:Lacosamide; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000639:trends; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide