Lacosamide in Lennox-Gastaut Syndrome

Abstract

Lennox Gastaut syndrome may exacerbate tonic seizures and electrical pattern of patients with LGS.

Use of lacosamide in Lennox-Gastaut syndrome: is it too premature?

“…In 2010, we described three consecutive patients with LGS experiencing a clear-cut worsening of TS (including tonic status) soon after starting treatment with LCM (5). Of course, these were only anecdotal reports, but other authors later confirmed our preliminary findings (6).…”

Should be prescribed lacosamide in patients with Lennox-Gastaut syndrome?

“…In other hands, in the report of Andrade-Machado et al (2), the aggravation of LGS was not only due to the effect of lacosamide on clinical seizures, it was also, in the worsening of the encephalopathic electrographic patterns, fast rhythms. We also know that most of the tonic seizures in LGS are subtle and only saw in polygraphic video-EEG recordings (6).…”

“…The results are interesting and controversial in a face of various previous reports that informed a worsening of tonic seizures and fast rhythms in patients with Lennox-Gastaut syndrome treated with lacosamide (2)(3)(4).…”

Efficacy and tolerability of add-on Lacosamide in children with Lennox-Gastaut syndrome

“…We should bear in mind that to unequivocally demonstrate AED-induced aggravation of seizures, it would be necessary to demonstrate improvement after its suspension or reduction, followed by renewed worsening secondary to its reintroduction (6). For legitimate and obvious ethical issues, neither Italiano et al (2) nor Andrade-Machado et al (3) followed such a procedure with their patients. On this basis, it could be stated that definite proof of a direct relationship between Lacosamide treatment and tonic seizure aggravation was lacking in the patients they described (2,3).…”

“…For legitimate and obvious ethical issues, neither Italiano et al (2) nor Andrade-Machado et al (3) followed such a procedure with their patients. On this basis, it could be stated that definite proof of a direct relationship between Lacosamide treatment and tonic seizure aggravation was lacking in the patients they described (2,3).…”