Authors :
Presenting Author: JuleLayne Curry, MD – University of Tennessee Health Science Center
Jacob Dohmeier, MD – Medical student/Clinical Research Assistant, Neurology, University of Tennesee Health Science Center; Basan Mudigoudar, MD – Associate Professor, Pediatric Neurology, Le Bonheur Children's Hospital; James Wheless, MD – Professor, Pediatric Neurology, Le Bonheur Children's Hospital; Nitish Chourasia, MD – Assistant Professor, Pediatric Neurology, Le Bonheur Children's Hospital
Rationale: Neonatal seizures are the most common manifestation of neurological disorders in the newborn period. Phenobarbital (PHB) is widely used and effective in neonatal seizures, despite known concerns for neurotoxicity. As a result, other newer anti-seizure medications (ASMs) such as levetiractem (LEV) have been explored (well before adequate controlled studies for use in this age group) owing to its safety profile, efficacy and lack of neuronal apoptosis and possible neuroprotective effects in animal studies. A randomized controlled trial recently found that PHB was more effective than LEV for the treatment of neonatal seizures, although with higher rates of adverse effects. Thus, continued evaluation of alternate ASMs with favorable treatment and adverse effect profile in neonates are warranted. Lacosamide (LCM) is a third generation ASM currently approved for focal seizures in children > 1 month of age. Increasing reports have described its use in neonatal age group, however there is insufficient evidence for its efficacy and safety. We describe our experience with LCM as an adjunct ASM for treatment of neonatal seizures in our single center cohort.
Methods: A retrospective chart review over a four year period (2018 to 2022) was conducted at Le Bonheur Children’s Hospital to identify electrographically confirmed neonatal onset seizures in babies who were treated with LCM. Data collected included electroclinical seizure characteristics, underlying etiology, ASMs used (sequence and dosing), response to treatment and any adverse effects. Treatment response to LCM in our study was defined as cessation of seizures (clinical or EEG) based on clinical report and on subsequent EEGs, following the addition of LCM to the ASM regimen or following the increase of their LCM dosage without administration of additional ASMs.
Results: A total of fifteen neonates (including eight females) with electroencephalogram confirmed seizures who were treated with LCM were included. The median age at seizure diagnosis was three days (IQR 1-4).The etiologies for seizures included HIE in four, meningitis in three, genetic in two, intracranial hemorrhage in two, congenital structural abnormalities in two, while etiology was unknown in one. Four neonates had electrographic only seizures while electrographic and clinical seizures were noted in eleven. Median LCM loading dose was 10 mg/kg (IQR 5-10) in fouteen neonates (one did not receive a loading dose) and median initial maintenance dose was 10 mg/kg/d (IQR 5-10) and median final maintenance dose was 13 mg/kg/d (IQR 10-14) among the fifteen neonates. Ten neonates achieved seizure freedom after LCM was added to the ASM regimen, in six when LCM was added as a third line and in four when LCM was used as second line. No unique treatment related adverse effects were noted.
Conclusions: LCM is effective as an adjunct for treatment of neonatal seizures in combination with other established first line ASMs in this age group. Further randomized trials are warranted.
Funding: None