First experiences with Lacosamid for treatment of therapy-resistant epilepsy in early childhood

Lacosamid is a newly approved anticonvulsant drug for the treatment of focal and secondary generalized seizures in young patients over the age of 16 years. Its major effect is probably to accelerate the slow inactivation of the sodium channels in neurons. Data on young children receiving therapy with Lacosamid are not yet available. We report our first experiences using Lacosamid in young children with therapy-resistant epilepsy. A group of 16 children with the following diagnoses was treated: CSWS, symptomatic focal seizures, LGS, Angelman syndrome, inversion duplication of chromosome 15. Children's age at the onset of treatment with Lacosamid: 8 boys (age: 72–201 months; ˜130 months) and 8 girls (age: 22–152 months; ˜83 months). Nearly all children were experiencing daily seizures before treatment was started.

Comedication comprised a broad spectrum of anticonvulsant drugs, without favoring any particular drug. Initial dosage: beginning with 1mg/kg body weight, increasing by 1–2mg/kg body weight/week to a maximum total dosage of 14mg/kg body weight. The target dosage was selected according to the effect and clinical tolerance. Lacosamid therapy was conducted for a period of 6–18 months. An ECG was performed on all children prior to treatment and on reaching the final dosage.

Results: Lacosamid was well tolerated, 2 children had to terminate the therapy due to a disturbed appetite resulting in weight gain and weight loss respectively. None of the children developed cardiac arrhythmia. The various comedication was not modified in any cases at the beginning of treatment, anticonvulsant drugs that are specifically effective on sodium channels were not reduced. 3 children were transferred to a Lacosamid monotherapy.5/16 (31.25%) became free of seizures; 3/16 (18.75%) showed a seizure rate reduction of 75%, no effect occurred in 6/16 (37.75%), both children with CSWS (12.50%) benefited from an improved ECG.

Summary: Lacosamid is a well tolerated and effective new anticonvulsant drug also suitable for young children with therapy-resistant epilepsy; an initial dosage of 1–2mg/kg body weight Lacosamid increasing weekly by the same dosage is clinically well tolerated; appetite disturbances while on Lacosamid must be further monitored. The study group is too small to be able to make recommendations regarding specific syndromes. None of the children developed cardiac arrhythmia.