Authors :
Presenting Author: Edgard Andrade, MD, MS – University of Florida
Michael Lattanzi, MD – University of Florida
Parrish Winesett, MD – University of Florida
Rationale:
Early-onset epilepsy poses a significant therapeutic challenge due to the limited number of antiseizure medications (ASMs) approved for use in infants. This population frequently presents in status epilepticus (SE). Traditional first-line treatments, such as benzodiazepines and fosphenytoin, may fail in some cases. Recent studies have suggested that lacosamide offer benefits in refractory epilepsies1. This case series explores the long-term efficacy outcomes associated with lacosamide in four infants with varied etiologies of early-onset epilepsy, all of whom presented in SE.Methods:
We retrospectively analyzed the long-term outcome of four infants (aged 2 to 9 months) with early-onset epilepsy of diverse etiologies. All patients presented in SE that was unresponsive to standard first-line therapies including lorazepam, fosphenytoin, phenobarbital, and in some cases, oxcarbazepine or levetiracetam. Each patient was subsequently treated with a regimen that included intravenous lacosamide, and treatment response was monitored via continuous video-EEG telemetry.Results:
In all four cases, SE was halted rapidly after lacosamide was introduced, either as monotherapy or in combination with other ASMs. At outpatient follow-up (ranging from several weeks to months), all patients demonstrated well-controlled epilepsy with no recurrence of SE. No patient experienced significant adverse effects attributed to lacosamide. Notably, the use of lacosamide was associated with long-term seizure control in infants who were otherwise pharmaco-resistant.Conclusions:
This case series supports the safety and potential efficacy of lacosamide in managing early-onset epilepsy, particularly in infants presenting with refractory SE. The rapid resolution of seizures and the absence of cardiac conduction abnormalities, combined with favorable long-term outcomes, suggest that lacosamide may be a valuable addition to the early treatment algorithm for infantile epilepsy2. Further prospective studies with larger cohorts are warranted to confirm these findings and to establish optimal dosing protocols in this vulnerable population.
References
1. Ortiz de la Rosa JS, Ladino LD, Rodríguez PJ, Rueda MC, Polanía JP, Castañeda AC. Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review. Seizure 2018;56:34-40. (In eng). DOI: 10.1016/j.seizure.2018.01.014.
2. Vossler DG, Bainbridge JL, Boggs JG, et al. Treatment of Refractory Convulsive Status Epilepticus: A Comprehensive Review by the American Epilepsy Society Treatments Committee. Epilepsy Curr 2020;20(5):245-264. (In eng). DOI: 10.1177/1535759720928269.
Funding: None