Lacosamide in children with refractory status epilepticus. A multicenter Italian experience.
OBJECTIVE
Status epilepticus (SE) is considered a life-threatening medical emergency. First-line treatment with antiepileptic drugs (AEDs) consists of intravenous benzodiazepines followed by phenytoin. SE is considered refractory (RSE) when unresponsive to standard doses of the first two AEDs. Scarce evidence is available to support specific guidelines for the management of RSE in either adults or children. This study aimed to assess the efficacy and tolerability of intravenous (iv) lacosamide (LCM) in children affected by RSE.


METHODS
Children with RSE who were treated with ivLCM were included in the study. Efficacy was defined as the cessation of seizures after administration of ivLCM, with no need for any further antiepileptic drug. All patients had been unsuccessfully treated following standard protocols before ivLCM was administered.


RESULTS
Eleven children entered the study (mean age: 9.4 years). Etiology was symptomatic in 7 patients (63%). RSE was convulsive (focal or generalized) in 6 patients and nonconvulsive in 5. The mean initial bolus dose of LCM was 8.6 mg/kg. The drug, which was used as a fourth or later option, was effective in stopping RSE in 45% of patients, with seizures terminating within 12 h in three children. No serious adverse events attributable to LCM were reported.


CONCLUSIONS
LCM might be an effective and well-tolerated AED in children with RSE.
Pediatric Neurology-Immunology and Endocrinology Unit, University of Siena, Italy; Department of Pediatrics, University of Siena, Italy. Electronic address: grosso@unisi.it.
Salvatore
S
Grosso
Child Neuropsychiatric Unit, University of Ancona, Italy.
Nelia
N
Zamponi
Clinical Neurophysiology, University of Perugia, Italy.
Arnaldo
A
Bartocci
Child Neuropsychiatric Unit, University of Ancona, Italy.
Elisabetta
E
Cesaroni
Child Neuropsychiatric Unit, University of Ancona, Italy.
Silvia
S
Cappanera
Department of Pediatrics, University of Siena, Italy.
Rosanna
R
Di Bartolo
Department of Pediatrics, University of Siena, Italy.
Paolo
P
Balestri
D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007558:Italy; D000078334:Lacosamide; D008297:Male; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use
D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide; D014635:Valproic Acid
Antiepileptic drug; Antiepileptic drugs; Epilepsy; Seizure; Status epilepticus