Abstracts

Rationale: Epilepsy that has proven intractable to multiple antiepileptic medications has a low probability of achieving reduction in seizure frequency with the addition of another drug. Promising results, however, have been obtained in adult epilepsy populations with Lacosamide as adjunctive therapy. To date, there is no pediatric data published on the efficacy of Lacosamide. We report 8 adolescent patients with intractable epilepsy treated with Lacosamide as an adjunctive therapeutic agent. Methods: Retrospective chart review was performed on the patients seen at Children s Hospital of Pittsburgh from 01/2009 to 04/2010 treated with Lacosamide. Data regarding demographics, seizure type, neurologic diagnoses, previous antiepileptic medications and other treatments used were collected and analyzed. Seizure frequency prior to and following treatment with Lacosamide was obtained by report of parent/primary caregiver. Results: Eight patients, 4 males and 4 females, treated with Lacosamide were identified. Ages ranged from 11 to 18 years, mean age 15. Primary neurologic diagnoses included encephalitis, neonatal stroke, sequelae of prematurity, Aicardi syndrome, Tuberous Sclerosis Complex Type 1 and pervasive developmental delay with autistic features. Seizure types included complex partial with and without secondary generalization, simple partial, atypical absence, tonic, and myoclonic. Various combinations of all antiepileptic medications available in the United States with the exception of felbamate and ethosuximide had either previously been used or were currently being given. Seven patients were using a vagal nerve stimulator prior to starting Lacosamide. Two patients had previously tried the ketogenic diet. One patient had a prior corpus callosotomy and the patient with Tuberous Sclerosis Complex had a prior right temporal lobectomy. Prior to starting Lacosamide all patients were having seizures no less frequently than once per week, with the majority having multiple seizures per week and 2 patients having daily events. Lacosamide doses used were between 100mg BID and 200mg BID, a range from 3 to 10 mg/kg/day by weight. 7 patients experienced an increase in total number of seizure free days by between 15 and 79% as reported by their parent/primary caregiver. One patient, prior to starting Lacosamide, had multiple daily complex partial and secondarily generalized seizures. After addition of Lacosamide the patient continued to have daily complex partial seizures, but the frequency of the secondarily generalized seizures decreased by 50%. Conclusions: This case series illustrates that adjunctive treatment with Lacosamide may reduce seizure frequency in adolescents with epilepsy intractable not only to other antiepileptic medications but, to other treatment modalities as well, including VNS, ketogenic diet and surgery. Further study is warranted in the pediatric age groups.