Efficacy and Tolerability of Lacosamide in the Treatment of Children With Refractory Generalized Epilepsy

Abstract

Lacosamide is FDA-approved in patients 17 years or older with partial-onset epilepsy. We evaluated the efficacy and tolerability of lacosamide in children with refractory generalized epilepsy. We retrospectively reviewed records of 21 children with refractory generalized epilepsy treated with lacosamide in our institution from 2009-2013 divided into 2 subgroups- I, Lennox-Gastaut Syndrome, and II, other generalized epilepsies. Efficacy was defined as seizure freedom or ≥50% seizure reduction. Descriptive data analysis including seizure freedom was compared using c(2) analysis. There were eleven females and ten males with a mean age, of 11.9 years. Five patients became seizure free, nine had ≥50% seizure reduction, and seven had no response. Group I: seven had ≥50% improvement, one did not respond. Group II: five became seizure free, two had ≥50% improvement, five had no response. Lacosamide is effective and well tolerated in children with refractory generalized epilepsy particularly patients with Lennox-Gastaut Syndrome.

Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review

“…Seizure worsening with lacosamide was also reported in two patients with LGS by Heyman et al [33], one patient by Andrade-Machado et al [24], and one patient by Yorns et al [21]. Casas [19], Miskin [11] and Rastogi [7] did not report seizure aggravation on patients with LGS. Overall, we found half of the patients with Lennox Gastaut syndrome showed 50% or greater seizure reduction, 32% did not response to lacosamide and 17% suffered seizure aggravation.…”

Lacosamide use in children with epilepsy: Retention rate and effect of concomitant sodium channel blockers in a large cohort

“…An open‐label study to determine safety, tolerability, and efficacy of oral LCM in children with epilepsy (clinicaltrials.gov identifier NCT00938912) is being conducted in children 1 month to 17 years of age, but the study has not yet been completed. A number of observational studies on the off‐label use of LCM as a maintenance AED in children has been reported (see Table ), but have the limitations of short follow‐up times, variable or unspecified time points for efficacy assessment, small sample sizes, and the retrospective use of the 50% responder rate outcome measure.…”

Role of observational studies in supporting extrapolation of efficacy data from adults to children with epilepsy — A systematic review of the literature using lacosamide as an example

“…A single study included 21 children with generalised epilepsies, including eight with LGS. 36 Seizure aggravation was not reported. In the study by Yorns et al, one patient with JME who had been experiencing several GTCs per day at study start, was seizure-free for over a year after LCM initiation.…”

“…One study included 21 children with generalized epilepsies only. 36 At 3 months, !50% reduction in seizure frequency was 43% and seizure freedom 24%. None of the eight children with LGS became seizure-free; however, seven (87.5%) experienced !50% reduction in seizure frequency.…”