Lacosamide safe, effective for childhood epilepsy with centrotemporal spikes

Lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes was well tolerated and resulted in significantly reduced seizures, according to a study published in Brain and Development.

“Childhood epilepsy with centrotemporal spikes is an age-limited epilepsy syndrome,” Tohru Okanishi, MD, PhD, associate professor of child neurology at Tottori University in Japan, and colleagues wrote. “Although the use of antiepileptic drugs is not always recommended, the frequency of seizures, daytime seizures or the evolution to bilateral tonic-clonic seizures warrant the use of medical treatments.”

Seeking to examine the safety and efficacy of lacosamide monotherapy for the treatment of childhood epilepsy with centrotemporal spikes (CECTS), Okanishi and colleagues conducted a retrospective, multicenter study that included 18 children (12 boys, 6 girls; mean age, 7 years), all of whom developed seizures between the ages of 3 and 13. In addition, all participants demonstrated at 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. They measured seizure occurrence 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 39% of participants were seizure-free from baseline to 3 months, 67% were seizure-free from 4 to 6 months and 72% were seizure-free at 7 to 12 months. Further, 72% of patients achieved seizure freedom within 4 months of treatment, while 83% gained seizure freedom by the last follow-up.

Four patients (22%) experienced adverse events, which included somnolence and fatigue; however, symptoms disappeared within 4 weeks. No cognitive disturbance was observed during the maintenance treatment period, and no severe adverse events were observed in any patient. All patients continued treatment with lacosamide during follow-up.

“Due to its efficacy, few adverse effects and tolerability, lacosamide may be a suitable first-line drug for CECTS,” Okanishi and colleagues wrote.