Elsevier

Seizure

Volume 56, March 2018, Pages 34-40
Seizure

Review
Efficacy of lacosamide in children and adolescents with drug-resistant epilepsy and refractory status epilepticus: A systematic review

https://doi.org/10.1016/j.seizure.2018.01.014Get rights and content
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Highlights

  • Lacosamide is a good option in children with focal drug-resistant epilepsy.

  • Lacosamide is a safe and well-tolerated antiepileptic drug for refractory epilepsies.

  • The efficacy of lacosamide in generalized epilepsies shows conflicting data.

  • Seizure worsening with lacosamide is more frequent in generalized epilepsies.

  • The efficacy of lacosamide in pediatric status epilepticus shows scarce data.

Abstract

Purpose

Lacosamide, is one of the newer antiepileptic drug approved for focal drug-resistant epilepsy as an add-on treatment in patients older than 16 years. However, there is growing evidence of its use, safety and efficacy in children. We aim to evaluate efficacy and tolerability of lacosamide in focal and generalized drug-resistant epilepsy and refractory status epilepticus in the pediatric population.

Methods

We conducted a systematic review on MEDLINE, EMBASE, COCHRANE, Google Scholar and Scielo from January 2008 to January 2017. The primary outcome was the efficacy of lacosamide in children with drug-resistant epilepsy and refractory status epilepticus. Efficacy and adverse events attributed to lacosamide were extracted from each publication and systematically reported. We performed no meta-analyses due to limited available data.

Results

Of 175 abstracts identified by the search, 82 were reviewed as full-text. Twenty-six articles fulfilled eligibility criteria and described outcomes in 797 patients (57% male). The majority of studies were retrospective (69%) small series (84%). On average 51% of patients had 50% or greater seizure reduction. The mean seizure freedom rate was 24%. Adverse effects occurred in 18–59% of patients. The main events were dizziness, sedation, gastrointestinal upset, mood and behavioral changes. Half of the patients with Lennox Gastaut syndrome showed 50% or greater seizure reduction, 32% did not response to lacosamide and 17% suffered seizure aggravation.

Conclusion

Current evidence shows lacosamide as a good option in pediatric patients with focal drug-resistant epilepsy and refractory status epilepticus as an add-on therapy given its efficacy on seizure control and safety profile. The use of lacosamide in Lennox-Gastaut syndrome shows conflicting data. Large randomized controlled studies in the pediatric population are necessary to substantiate these findings.

Keywords

Adds-on therapy
Behavior
Efficacy
Refractory epilepsy
Safety
Side effect

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