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Case Reports: Learning from unexpected outcome (positive or negative)
Response of focal refractory status epilepticus to lacosamide in an infant
  1. Asra Akbar1,
  2. Aaron A Harthan2,
  3. Sean Creeden3 and
  4. Girish G Deshpande4
  1. 1Pediatric Neurology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
  2. 2Pharmacy, OSF HealthCare System, Peoria, Illinois, USA
  3. 3Radiology, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
  4. 4Pediatric Critical Care, University of Illinois College of Medicine at Peoria (UICOMP), Peoria, Illinois, USA
  1. Correspondence to Dr Asra Akbar; aakbar1@uic.edu

Abstract

Status epilepticus (SE) is a life-threatening medical emergency which is frequently encountered in the critical care setting and can be refractory to treatment. Refractory status epilepticus (RSE) is defined as SE that has failed to respond to adequately used first-line and second-line antiepileptic medications. Super refractory status epilepticus is defined as SE that persists for 24 hours or more after the use of an anaesthetic agent or recurs after its withdrawal.

If SE persists beyond a period of 7 days it is referred to as prolonged, refractory status epilepticus (PRSE). There are limited data guiding treatment of RSE in the paediatric population.

Lacosamide (LCM) is licensed as an adjunctive treatment for partial-onset seizures. Evidence for the efficacy of LCM in paediatric SE is scarce. This case report may suggest a synergistic effect of LCM on slow-activation sodium channels in conjunction with medications such as phenytoin that causes fast inactivation of sodium channels. The dual fast and slow inactivation of sodium channels may enhance the effectiveness in treatment of RSE. This is the first case report of PRSE in an infant, successfully treated with LCM. A brief review of literature is also a part of this report.

  • Paediatric intensive care
  • Neurology
  • Drugs: CNS (not psychiatric)
  • Epilepsy and seizures
  • Neonatal and paediatric intensive care

https://doi.org/10.1136/bcr-2022-249948

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    Footnotes

    • Contributors AA wrote the manuscript. GGD and AAH extensively modified the manuscript. SC provided the radiographic images and input. All authors have reviewed and made changes to the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.