Response of focal refractory status epilepticus to lacosamide in an infant

Abstract

Status epilepticus (SE) is a life-threatening medical emergency which is frequently encountered in the critical care setting and can be refractory to treatment. Refractory status epilepticus (RSE) is defined as SE that has failed to respond to adequately used first-line and second-line antiepileptic medications. Super refractory status epilepticus is defined as SE that persists for 24 hours or more after the use of an anaesthetic agent or recurs after its withdrawal.If SE persists beyond a period of 7 days it is referred to as prolonged, refractory status epilepticus (PRSE). There are limited data guiding treatment of RSE in the paediatric population.Lacosamide (LCM) is licensed as an adjunctive treatment for partial-onset seizures. Evidence for the efficacy of LCM in paediatric SE is scarce. This case report may suggest a synergistic effect of LCM on slow-activation sodium channels in conjunction with medications such as phenytoin that causes fast inactivation of sodium channels. The dual fast and slow inactivation of sodium channels may enhance the effectiveness in treatment of RSE. This is the first case report of PRSE in an infant, successfully treated with LCM. A brief review of literature is also a part of this report.

Safety of intravenous lacosamide in hospitalized children and neonates

“…[9][10][11][12][13][14][15][16] To date, the largest study on pediatric use of IV LCM included 47 children, 9,12 and two case reports described the efficacy of IV LCM in nonneonatal infants with refractory status epilepticus. 10,16 One case report described efficacy of oral LCM in a 3-week-old infant, but did not specifically report AEs. 17 Although a recent case series reported the absence of teratogenic findings in neonates born to mothers with epilepsy who were taking LCM during pregnancy, 18 no studies have evaluated the safety of IV LCM in neonates.…”

“…Although oral LCM has been shown to be generally effective and well tolerated by children with epilepsy, 5 few studies describe the effects of IV LCM in children. [9][10][11][12][13][14][15][16] To date, the largest study on pediatric use of IV LCM included 47 children, 9,12 and two case reports described the efficacy of IV LCM in nonneonatal infants with refractory status epilepticus. 10,16 One case report described efficacy of oral LCM in a 3-week-old infant, but did not specifically report AEs.…”