Lacosamide monotherapy promising therapy for childhood epilepsy with centrotemporal spikes

JAPAN: A study published in Brain and Development shows that lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes (CECTS) is well tolerated and reduces seizures significantly with fewer adverse effects. Therefore, lacosamide may be a good candidate as a first-line medication for the treatment of new-onset CECTS.

Childhood epilepsy with centrotemporal spikes is an age-limited focal epilepsy syndrome, with a typical onset at 5–8 years. It accounts for 15–20% of all childhood epilepsies. The use of antiepileptic drugs is not always recommended but the frequency of seizures, daytime seizures, or the evolution to bilateral tonic-clonic seizures warrant the use of medical treatments.

Tohru Okanishi, associate professor of child neurology at Tottori University in Japan, and colleagues conducted a retrospective, multicenter study to examine the safety and efficacy of lacosamide (third-generation antiepileptic drug ), monotherapy for the treatment of CECTS. 18 children (12 boys, 6 girls; mean age, 7 years), all of whom developed seizures between the ages of 3 and 13 were included in the study. Participants also demonstrated minimum hemifacial or oropharyngeal seizures and interictal discharges in central and/or middle temporal electrodes had no intellectual disability and were treated with lacosamide for 6 months.

Researchers started participants on lacosamide at 2 mg/kg per day twice daily and increased it to 4 mg/kg per day in patients weighing 30 to 50 kg and to 6 mg/kg per day in patients weighing less than 30 kg. Seizure occurrence was measured at 0 to 3 months, 4 to 6 months, and 7 to 12 months from treatment initiation as well during the last 6 months of follow-up.

Results showed that

• Of all the patients, 39%, 67%, and 72% were seizure-free during 0–3, 4–6, and 7–12 months from treatment initiation, respectively.

• Further, 72% of patients were seizure-free within 4 months of treatment, Seizure freedom was achieved in 72% during the first 4 months of treatment

• 83% gained seizure freedom by the last follow-up.

• All patients continued lacosamide monotherapy during the study, although four patients showed transient fatigue or somnolence. However, the symptoms disappeared within 4 weeks.

• No cognitive disturbance was observed during the maintenance treatment period

• There were no severe adverse events in any patient.

During follow-up, all patients continued treatment with lacosamide.

Author Okanishi and colleagues thus concluded," Lacosamide showed promising efficacy for controlling seizures with fewer adverse effects, and therefore may be a good candidate as a first-line medication for the treatment of new-onset CECTS."

Reference:

Okanishi T, Fujii Y, Sakuma S, Shiraishi H, Motoi H, Yazaki K, Enoki H, Fujimoto A. Lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes. Brain Dev. 2022 Jun;44(6):380-385. doi: 10.1016/j.braindev.2022.02.005. Epub 2022 Feb 28. PMID: 35241306.