Abstracts

Rationale: Lacosamide, a new AED with a unique effect on sodium channels, is approved for use in people 17 y.o. or older. It has an intravenous formulation but very little is known about safety and tolerability in infants and young children. We report our experience with the use of intravenous formulation of Lacosamide in critically ill infants and children.Methods: After IRB approval, pharmacy records were used to identify all doses of IV-LCM from 2008 to May 2011. Inclusion criteria for a chart review were: age 10 y.o. or less and at least 1 dose of IV-LCM was administered. Charts were audited for demographics, seizure types, indication for use, dose, safety, tolerability, and efficacy.Results: Nine patients, all with symptomatic seizures, 5 female, mean age 4.5 y.o. (range 6 months to 9 years) were identified. The mean dose of IV-LCM was 7.3 mg/kg (range 2 to 10 mg/kg). The concentration of IV-LCM was 10 mg/ml, and all doses were administered over a 30 minute interval. Four children (6 mo., 7 mo., 18 mo, and 7 years old) were in status epilepticus partial and secondarily generalized seizures. All 4 had been treated with 5 to 8 medications and were intubated, paralyzed, and recorded with video-EEG monitoring. Status stopped in 3, 2 became seizure free, 1 had seizures infrequently, and 1 did not respond. All were given IV-LCM 10 mg/kg. Two children had epilepsia partialis continua, and did not show any significant improvement. One child having 80+ frontal complex partial seizures/day had a decrease to 41 seizures after an initial dose of 5 mg/kg IV-LCM. One 9 y.o. was given IV-LCM because she had pancreatitis. Her seizure control was 90% improved over prior treatment. A 7 y.o. boy with status, had seizures controlled by midazolam and propofol and was given IV-LCM. There were no serious adverse events. No local irritation at the injection site, no significant change in EKG in the 5 children that were monitored.Conclusions: In this small group of infants and children IV-Lacosamide appears to be tolerated in doses of 10 mg/kg administered over 30 minutes. There were no systemic or local IV site complications or adverse effects. However, these children were critically ill and/or young and subjective adverse effects would not have been detected.