Efficacy of Lacosamide in Seizures Associated with Supplementary Motor Area
Abstract number :
2.263
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2025
Submission ID :
554
Source :
www.aesnet.org
Presentation date :
12/7/2025 12:00:00 AM
Published date :
Authors :
Presenting Author: SERKAN KIRIK, MD, Assoc. Prof. – Health Sciences University Elazig Fethi Sekin City Hospital
Yavuz Atas, MD, Dr – Health Sciences University Van Research and Training Hospital
Yasemin KIRIK, MD, Dr – Health Sciences University Elazig Fethi Sekin City Hospital
Rationale: Supplementary motor area (SMA) seizures are typically short-duration frontal lobe seizures often characterized by preserved consciousness and accompanied by hyperkinetic movements. The asymmetric tonic posture known as the “fencing posture” is a typical semiological feature of SMA-related seizures. Other seizure types, such as the "figure-4 sign" and less frequently tonic-clonic components, are also associated with SMA. Lacosamide is a third-generation antiseizure medication that enhances the slow inactivation of voltage-gated sodium channels, thereby reducing neuronal excitability. The aim of this study was to evaluate the clinical and electroencephalographic (EEG) efficacy of lacosamide monotherapy in non-lesional SMA seizures.
Methods: This retrospective study included 11 patients between January 2021 and January 2025 who had asymmetric tonic posture seizures, no detectable lesions on neuroimaging, no pathogenic variants in genetic testing, and normal metabolic screening results. Demographic data, seizure semiology, MRI, and EEG findings were reviewed. Seizure frequency and EEG changes before and after lacosamide (LCM) treatment were compared.
Results: Seven of the patients were female and four were male. At the 3-month follow-up, complete seizure freedom was achieved in 100% of the patients receiving lacosamide monotherapy. At the 12-month follow-up, interictal epileptiform discharges had completely resolved in 8 patients (72%), resulting in a normal EEG recording.
Conclusions: This study demonstrates that lacosamide is an effective treatment option for non-lesional SMA seizures. A marked improvement was observed in both seizure frequency and EEG findings, with minimal side effects. Based on current literature, this is the first study to demonstrate the efficacy of lacosamide monotherapy in treating non-lesional SMA-related seizures in the pediatric population.
Funding: No
Clinical Epilepsy