Universidad Nacional de Colombia, Bogotá DC, Colombia.
Epilepsy Program Hospital Pablo Tobón Uribe, University of Antioquia, Neuroclinica, Medellín, Colombia.
Seizure. 2018 Mar;56:34-40. doi: 10.1016/j.seizure.2018.01.014. Epub 2018 Feb 8.
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.
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.
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.
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.
拉科酰胺是一种新型抗癫痫药物，适用于 16 岁以上局灶性耐药性癫痫患者的附加治疗。然而，越来越多的证据表明其在儿童中的使用、安全性和疗效。我们旨在评估拉科酰胺在儿童局灶性和全身性耐药性癫痫和难治性癫痫持续状态中的疗效和耐受性。
我们对 MEDLINE、EMBASE、COCHRANE、Google Scholar 和 Scielo 进行了系统综述，检索时间为 2008 年 1 月至 2017 年 1 月。主要结局是拉科酰胺在耐药性癫痫和难治性癫痫持续状态儿童中的疗效。从每篇出版物中提取并系统报告拉科酰胺的疗效和不良反应。由于数据有限，我们没有进行荟萃分析。
通过搜索共确定了 175 篇摘要，其中 82 篇进行了全文审查。26 篇文章符合入选标准，描述了 797 例患者的结局（57%为男性）。大多数研究为回顾性（69%）小系列（84%）。平均 51%的患者有 50%或更多的发作减少。无发作的平均发生率为 24%。不良反应发生在 18-59%的患者中。主要事件为头晕、镇静、胃肠道不适、情绪和行为改变。半数 Lennox-Gastaut 综合征患者的发作减少 50%或更多，32%对拉科酰胺无反应，17%发作恶化。
目前的证据表明，拉科酰胺作为一种附加治疗药物，在儿童局灶性耐药性癫痫和难治性癫痫持续状态患者中是一种较好的选择，因为它具有控制发作和安全性的疗效。拉科酰胺在 Lennox-Gastaut 综合征中的应用存在矛盾的数据。需要在儿科人群中进行大规模的随机对照研究来证实这些发现。
