Authors :
Presenting Author: Alexandra Santana Almansa, MD – Boston Children's Hospital
Jessica Landers, MS – Boston Children's Hospital; Nicholas Abend, MD – Children's Hospital of Philadelphia; Giulia Benedetti, MD – University of Michigan; Catherine Chu, MD – Massachusetts General Hospital; Andrew Knox, MD – University of Wisconsin; Shavonne Massey, MD, MSCE – Children's Hospital of Philadelphia; Steffany Moen, MD, MS – Sanford Health; Andrea Pardo, MD – Lurie Children's Hospital; Renée Shellhaas, MD, MS – University of Michigan; Tammy Tsuchida, MD, PhD – Children's National Hospital; Cameron Thomas, MD, MS – Cincinatti Children's Hospital Medical Center; Sonya Wang, MD – University of Minnesota; Arnold Sansevere, MD – Children's National Hospital; Janet Soul, MDCM – Boston Children's Hospital
Rationale:
Anti-seizure medications (ASMs) for neonatal seizures are used off-label except for phenobarbital. We hypothesized that lacosamide (LCM) may be safe and effective for neonatal seizures.
Methods:
We conducted a 10-center, retrospective study of LCM use in neonates born between 2008 to 2020 with seizure onset < 44 weeks postmenstrual age (PMA) and LCM treatment initiated by ≤48 weeks PMA. Clinical data were collected from medical records and available EEG data were analyzed.
Results:
We identified 62 eligible neonates (Table 1), and found that LCM was administered as the fourth line or later ASM in 93%. The first LCM dose (median 5.0 mg/kg, IQR 2.5, 10.0) was given at a median PMA of 40.3 weeks (IQR 39.1, 43.1). A median of 4 (3,5) ASMs were administered prior to LCM and 55% did not receive another ASM after LCM administration. Seizure cessation, defined as permanent end of clinical and/or EEG-proven seizures during the inpatient stay, occurred after LCM administration in 37% of neonates, including 21% for whom no other ASM was administered and 16% who had one or more additional ASMs administered.
Neonates with seizure cessation on LCM had lower seizure burden 24 hours prior to first LCM dose (p= 0.035), four hours after first LCM dose (p = 0.025), 24 hours after first LCM dose (p = 0.006), and on the first day of highest daily LCM maintenance (p < 0.001) compared to neonates without seizure cessation (Figure 1). For 72% of neonates, LCM was continued at hospital discharge. Among the 28% with LCM discontinued, the reasons included lack of efficacy (69%), seizure resolution/simplification of ASM regimen (23%), and replacement with a different ASM (8%).