Effectiveness and Adverse Effect of Intravenous Lacosamide in Nonconvulsive Status Epilepticus and Acute Repetitive Seizures in Children

Abstract

Nonconvulsive status epilepticus (NCSE) and acute repetitive seizures (ARS) are associated with significant morbidity and mortality. Due to the lack of randomized-controlled trials of intravenous antiepileptic drugs (AEDs) in these conditions, trials of a new generation of AEDs in this aspect are needed. A prospective interventional study was conducted in children under 18 years of age with NCSE or ARS who either had contraindication to or were refractory to first-line AEDs and received intravenous lacosamide. Demographic data, the efficacy of treatment, and adverse effects were recorded. Eleven patients with a median age of 11 years, predominantly female (72.7%), were enrolled. Average loading dose was 227 mg (8.3 mg/kg/dose) and average daily maintenance dose was 249 mg (4.6 mg/kg/dose). All patients (100%) experienced a reduction in seizure frequency within 24 hours. Eight of eleven patients (72.7%) experienced a reduction in seizure frequency of more than 50% by the end of the study, and one patient became seizure-free. In terms of adverse events, one patient had a bradycardia without prolongation of the PR interval. Interestingly, there was a case of neuronal ceroid lipofuscinosis in which a significant improvement in seizure control was achieved. The results indicate that intravenous lacosamide may be an alternative treatment for NCSE or ARS in children. To our knowledge, this is the first study on the use of intravenous lacosamide in Asian children. This study is registered to Thai Clinical Trials Registry (TCTR) and the trial registration number is TCTR20180508004.

Anticonvulsive Drug Use in Status Treatment in Children

“…Recently, a reduction of seizure frequency of more than 50% was reported in a prospective study applying intravenously lacosamide to 11 children (median age 11 years) with nonconvulsive SE and acute repetitive seizures. Here, the loading dose was on average 8.3 mg/kg/dose, and the average maintenance dose was 4.6 mg/ kg/d (Ngampoopun et al 2018). Lang et al recently reported a 70% cessation rate of seizure series or SE in a mixed pediatric and adult cohort of 119 patients who received lacosamide with a good tolerability (Lang et al 2016).…”

Benign Prostatic Hyperplasia in African American Men Merits Greater Consideration in Academic Medicine

“…Despite an increased prevalence of BPH, the literature has consistently shown that African Americans are undertreated for BPH. Multiple studies have also shown that non-Caucasian men are at an increased risk of postoperative morbidity and mortality following surgical intervention for BPH [23][24][25]. The extent of disease progression at the time of BPH diagnosis should also be considered in the analysis of the frequency of surgery and subsequent complication rates among black men.…”

“…It contains seven questions related to BPH symptoms and one question related to the patient's perceived quality of life. BPH symptom severity is proportionate to the IPSS score, which ranges from 0 to 35 and categorizes symptoms as mild (1-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), or severe (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The IPSS survey is widely used in Urology and the AUA also encourages its use in primary care settings.…”

Status epilepticus im Kindes- und Jugendalter – ein oft unterschätztes Notfallereignis

“…Erste Reviews, die teilweise auch pädiatrische Patienten enthalten, zeigen für Lacosamid insgesamt eine gute Datenlage [19,21,24,34]. In einer Studie bei 522 (erwachsenen) Patienten konnte bei 57 % der Patienten mit SE eine Anfallsbeendigung erreicht werden, vor allem aber bei 92 % der Patienten mit fokalem SE [34].…”