Intravenous lacosamide therapy for pediatric patients with cluster seizures

Abstract

ObjectiveFew studies have investigated intravenous lacosamide use to treat cluster seizures in pediatric patients. Therefore, we aimed to investigate the efficacy and safety of intravenous lacosamide therapy in pediatric patients with cluster seizures. MethodsWe retrospectively evaluated the efficacy and safety of intravenous lacosamide therapy in 25 pediatric patients with cluster seizures at Saitama Children’s Medical Center between March 2019 and June 2023. Cluster seizures were defined as a single seizure of <5-min duration, repeated ≥3 times within 12 h, with recovery of consciousness between seizures. Response was defined as seizure freedom for at least 12 h after lacosamide infusion. ResultsThe median age at onset of epilepsy was 1.5 (0.0–9.8) years. The median seizure frequency was five (3–20) times/12 h. The etiologies were remote (n=17), acute (n=4), or progressive (n=4). The most common seizure type was focal motor seizure (n=12). The median age at which intravenous lacosamide therapy was administered was 4.2 (0.0–11.3) years. The median lacosamide dose was 2.6 (1.3–5.2) mg/kg. In total, 12/25 patients (48.0%) responded. Among patients treated with intravenous lacosamide as first-line therapy, 9/17 (52.9%) had complete seizure remission. The frequency of complete seizure remission in patients with remote etiologies was 58.8% (10/17); among them, 7/12 (58.3%) patients with structural abnormalities showed complete seizure remission. No adverse events were observed. ConclusionIntravenous lacosamide therapy is a potentially useful treatment option for cluster seizures in pediatric patients.