Long‐term efficacy of add‐on lacosamide treatment in children and adolescents with refractory epilepsies: A single‐center observational study

Abstract

This study documents a real-world progressive and significant loss of LCM efficacy over time in a pediatric population. Further prospective studies on larger populations are required to confirm the remarkable loss of LCM efficacy over time.

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

“…In three studies, children with focal seizures responded better than those with generalized seizures, 30e32 and vice versa in another. 35 In three studies, there was no difference in response to LCM based on seizure type, including the largest prospective 29 and retrospective studies, 27,30 with a combined population of 441 patients.…”

“…Importantly, among the 40 children, 11 had failed resective surgery, nine ketogenic diet, and five VNS. Retention rate was the main outcome in two of the large studies; at 1-year, retention was 45% in the study by McGinnis and Kessler, 27 and 47.7% in the study by Rosati et al 30 Results were not broken down according to specific generalized seizure type; however, some overall insight was provided in most studies. In three studies, children with focal seizures responded better than those with generalized seizures, 30e32 and vice versa in another.…”

“…There were no reports of seizure aggravation in three studies. 27,30,32 In their large-scale prospective study, Casas-Fernandez et al reported an increase in seizure frequency in five (3.8%) patients; all had focal seizures (three with focal to bilateral seizures), but none discontinued. 29 In another prospective study, Verrotti et al reported an increase in seven (11.9%) patients, all of whom discontinued; four patients had generalised, two mixed, and one focal seizures.…”

“…35 Rosati et al did not observe significant differences in response based on epilepsy and seizure types e 12-month retention rate was 47.7% for all patients, and 41.8%, 69.2% and 50.0% for children with focal, generalized, and combined epilepsy, respectively. 30 They also analysed median time-to-relapse for responders with focal, generalized, or combined epilepsy, which was 45, 49, and 37 months, respectively. No significant differences were observed with regard to epilepsy and seizure type.…”

Switching from traditional sodium channel blockers to lacosamide in patients with epilepsy

“…The short follow-up duration in our study may have resulted in selection bias owing particularly to the long period of uptitration in our study protocol with a higher proportion of patients with rare seizures in the 'intermediate group'. Although other researchers have documented the efficacy of switching to LCM monotherapy in patients with epilepsy [12], one recent study reported rapid loss of efficacy of LCM in a pediatric epilepsy population [13]. We used retention of LCM after at least 6 months of follow-up as a marker of successful switching.…”