Abstracts

Rationale: There is little information regarding efficacy and tolerability of intravenous (iv) lacosamide (LCM) in pediatrics. We report our observation on 22 children less than 12 years old treated with iv LCM.Methods: All children given iv LCM were identified by automated search of pharmacy records from October 2009 to January 2013. Medical records were audited for demographics, seizure classification, etiology, EEG, imaging, dose of LCM, efficacy and tolerability. Results: 22 patients (16 female) were identified with median age 5.5 years, (4 weeks - 11 years), 6 < 2 years old, all with focal epilepsy. Etiologies included dysgenesis of cerebral cortex (6), infection (3), acquired lesions- stroke, trauma, hypoxic ischemic injury (7) or unknown (6). LCM solution [10 mg/ml] was infused over 30 minutes. Patients were separated in 3 groups based on the indication for iv LCM. Group 1: 5 patients with refractory status epilepticus (focal onset with secondary generalization) and 2 with epilepsia partialis continua (EPC) were given LCM as an adjunctive therapy to 2 antiepileptic drugs (AEDs). The median iv LCM dose was 8 mg/kg, range 5 - 10 mg/kg. Status was terminated by iv LCM infusion for 3/5 children and 1/2 children with EPC. All patients were naive to lacosamide. Infusions were tolerated without adverse effects. Group 2: 9 children received iv LCM for acute repetitive seizure exacerbation. Patients were concurrently treated with 2 AEDs. The median intravenous dose was 8 mg/kg, range 3 - 15 mg/kg. Infusion was beneficial in 7 patients; 4 had resolution of their seizures and 3 had 50% reduction. LCM was ineffective in 1 patient. 1 patient had an increase in seizure frequency and onset of generalized spike and slow wave complexes following the LCM infusion. Adverse events were noted in 4 patients: 2 sedation, 1 sedation with ataxia, and 1 increased seizure as noted above. All adverse events resolved within 24 hours. Group 3: 6 patients (4 naive to LCM) required iv formulation due to inability to receive or tolerate oral AEDs. Patients were concurrently treated with 1 AED. The median dose was 8 mg/kg, range 6 - 11 mg/kg. The infusion was effective for 3/4 LCM naive children with 50% reduction in seizure frequency. There was no change in seizures for the 2 patients who had iv LCM substituted for oral LCM. The infusions were tolerated well. Overall, 16/22 children converted to enteral LCM for long term therapy. Conclusions: In our cohort of children with focal epilepsy, iv LCM was effective and tolerated. Mild reversible side effects were reported. The treatment was effective in three different clinical settings, including status epilepticus, acute seizure exacerbation and need for parenteral administration. To our knowledge this is the first report of tolerability and efficacy of iv LCM in children exclusively less than 12 years of age, and specifically in those younger than 2 years. Additional study is needed to clarify optimal doses and rates of delivery of iv LCM, especially in the treatment of status epilepticus.