Efficacy of Intravenous Lacosamide in Treating Refractory Neonatal Seizures: A Retrospective Study
Abstract number :
3.322
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2024
Submission ID :
381
Source :
www.aesnet.org
Presentation date :
12/9/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Jeetendra Sah, MD – University of Louisville School of Medicine
Pradeep Javarayee, MD MBA – Medical College of Wisconsin
Siddharth Jain, MBBS MD – University of Louisville
Samir Karia, MD – University of Louisville School of Medicine/Norton Children's Hospital
Cemal Karakas, MD – University of Louisville School of Medicine/Norton Children's Hospital
Rationale: Neonatal seizures (NS) pose significant challenges, often necessitating use of multiple antiseizure medications (ASMs). Phenobarbital has consistently been used over the years despite effectively controlling seizures in only about 43% of cases, with alternatives like phenytoin and levetiracetam not demonstrating superiority. This study aimed to evaluate the efficacy of lacosamide (LCM) as an adjunctive ASM in treating refractory NS.
Methods: The study included neonates treated with LCM within 44-weeks of corrected gestational age who were treated at our center from January 2015 to December 2023. See details of collected data in Table 1. The primary outcome was the response to LCM, assessed by quantitative changes in seizure burden 24 hours before and after LCM administration by reviewing raw electroencephalogram (EEG) data by two pediatric epileptologists. The clinical characteristics were compared between responder and non-responder groups.
Results: Thirty-three neonates were identified, 18 of whom had raw EEG data and were included in the analysis. The demographic and clinical characteristics varied, including a range of etiologies such as HIE, intracranial hemorrhage, brain infection, cortical malformation, and genetic causes (Table 1). Our study cohort comprised of 61% male and average gestational age was 36.5 weeks (SD 4.8). The median age at first seizure was 3 days (IQR 1-8 days). In this cohort, 72% of neonates showed a favorable response, with more than 75% reduction in seizure burden following LCM administration (Figure 1). A median of 3 ASMs tried before LCM administration, with phenobarbital being the most common first-line ASM used. The median loading dose of LCM was 6 mg/kg/day, with a median maintenance dose of 5 mg/kg/day given in two divided doses. No statistically significant differences were observed between the groups in terms of gestational age, sex, race, mode of delivery, or seizure etiology.
Conclusions: This study is unique in quantitatively assessing neonatal seizure burden 24 hours before and after LCM use to evaluate its efficacy. The findings suggest that LCM can be an effective adjunctive ASM in the neonatal population. Further prospective studies are needed to confirm these results and to explore the long-term outcomes and safety profile of lacosamide in this vulnerable patient group.
Funding: There was no funding source for this research.
Clinical Epilepsy