Intravenous Lacosamide Effective Against Pediatric Cluster Seizures: Study

A recent study by Ryuki Matsuura and team found that intravenous lacosamide medication is both effective and safe for treating cluster seizures in young patients. The findings published in the recent issue of Pediatric Neurology journal corroborate previously reported short case series on this subject.

Seizures are among the most prevalent reasons for a neurology consult in the pediatric critical care unit. The increased use of continual electroencephalographic (EEG) monitoring in critically sick children with acute encephalopathy, electrographic seizures are frequently found. Because electrographic seizures are connected with poor neurobehavioral outcomes, most physicians try to stop them by giving anti-seizure drugs. Thus, these patients might benefit from intravenous anti-seizure pharmaceutical alternatives like lacosamide, which enhances the delayed inactivation of voltage-gated sodium channels.

The comprehensive research retrospectively examined the effectiveness and safety of intravenous lacosamide treatment in 25 pediatric patients having cluster seizures at Saitama Children's Medical Center from March 2019 to June 2023. Cluster seizures are characterized as a single seizure lasting  less than 5 minutes and repeated more than 3 times within 12 hours, with awareness recovery between each. The compliance was defined as seizure-free for at least 12 hours following lacosamide infusion.

The key findings of this study were:

The median age at epilepsy onset was 1.5 years. Also, the patients underwent an average of five seizures within a 12-hour period. The majority of patients (17 out of 25) had remote etiologies, with focal motor seizures being the most common type.

Out of the 25 patients, 48% patients responded positively to intravenous lacosamide by achieving seizure freedom. Also, 52.9% of patients who received lacosamide as a first-line therapy underwent complete seizure remission.

The patients with remote etiologies had a higher response rate, where 58.8% patients achieved complete seizure freedom. Among these, children with structural abnormalities expressed a notable 58.3% remission rate. Also, no adverse events were reported which highlighted the safety of lacosamide in this pediatric population.

The high remission rates, especially among the individuals with remote etiologies and structural abnormalities are particularly promising. These results could pave the way for more extensive clinical trials and based on the critical findings of this study, Intravenous lacosamide therapy may be considered as a potential therapeutic option for the children with cluster seizures.

Source:

Matsuura, R., Hamano, S., Kikuchi, K., Takeda, R., Takeuchi, H., Hirata, Y., Koichihara, R., Niitsu, T., Ueta, I., & Oka, A. (2024). Intravenous Lacosamide Therapy for Pediatric Patients With Cluster Seizures. In Pediatric Neurology (Vol. 157, pp. 1–4). Elsevier BV. https://doi.org/10.1016/j.pediatrneurol.2024.05.003