Abstracts

Rationale: Lacosamide (LCM) was FDA approved in 2009 as an adjunctive therapy for partial onset seizures in patients at least 17 years of age. It has a novel dual mode of action, is minimally protein bound, not associated with clinically significant laboratory abnormalities and has not shown to affect the mean plasma concentration of other antiepileptic drugs. Intravenous (IV) LCM has similar safety and tolerability to oral LCM when used as replacement therapy. We reviewed the use if IV LCM in children <17 yrs of age with status epilepticus (SE). Methods: We studied children who received at least one dose of IV LCM for SE at our tertiary care Children's hospital from Dec, 2011 to Mar, 2014 from a prospective database. SE was defined as continuous seizure activity of >20mins or two or more recurrent seizures without regaining baseline level of awareness. Review of their electronic medical records was performed. Efficacy was defined as seizure freedom or >50% reduction of seizures within 24 hours of administering LCM. Other IV antiepileptic drugs administered and any adverse reactions were also noted. Results: Nine children (5 females) met the criteria. Mean age was 5.7 years (range: 3 months to 16years) (Table 1). Six patients were only given one other IV antiepileptic drug (excluding individual benzodiazepine doses) prior to IV LCM administration. Oral TPM was administered via nasogastric tube to one of the patients which did not improve the seizures. The mean initial or loading dose of LCM was 8.7 mg/kg with 7 of 9 patients receiving a dose of 10 mg/kg. The average total amount of IV LCM administered within the initial 24 hours was 13.8 mg/kg. LCM was found to be efficacious in 7/9 (77.8%) patients. Four patients (44.4%) became seizure free. Two patients continued to be in SE within 24 hours of LCM administration (Table 2). Bradycardia was observed in one patient within 24 hrs of receiving LCM. Conclusions: Limited data is available for use of IV LCM in children in medical literature. Within the limitations of our open-label study in children with status epilepticus with co-administration of other IV antiepileptic drugs; we found LCM to be efficacious in 78% of the patients with 44% becoming seizure free. In addition no significant adverse reactions were observed. An appropriate safe, effective initial or loading dose may be 10 mg/kg. Further, prospective studies are required.