Abstracts

Rationale: CSWS is a rare condition associated with language and cognitive and behavioral changes. It is often difficult to treat with standard anticonvulsant therapy. Corticosteroids, as well as high dose diazepam often is used to change CSWS patterns, but often are limited in duration or have higher risks of side effects. These two refractive cases did respond to the combination of valproic acid(vpa), levitiracetam(lev) and lacosamide(lcsm) in combination therapy. This combination may be easier to use and offer less side effects than other therapies and may represent anti-epileptic combination that may be neuroprotective.Methods: Two refractive patients with CSWS were offered addition of lcsm at 2-4mg/kg and lev at 15-30mg/kg to existing valproic acid with levels > 100mg/ml in serum.Patients had 24 hour EEG data was collected before and after 8-16 weeks of therapy.Results: Therapeutic use of lev and lcsm added to baseline valproic acid showed resolution of CSWS in both cases after 8-12 weeks of therapy with correlating reports of academic and behavioral improvements.Conclusions: CSWS may benefit from rational polytherapy with vpa, lev, and lcsm. This may represent easily initiated therapy for CSWS with fewer side effects than corticosteroids or IVIG or high dose diazepam. Further clinical trials are warranted.