Monitorowanie terapeutyczne lakozamidu jako dodatkowe leczenie u noworodka z lekooporną epilepsją spowodowaną mutacją genu SCN2A: opis przypadku
Therapeutic drug monitoring of lacosamide as add-on treatment in a neonate with therapy-resistant epilepsy due to SCN2A mutation: a case report
W skrócie
Opisany przypadek dotyczy wcześniaka z ciężką epilepsją, która nie reagowała na standardowe leki przeciwpadaczkowe z powodu rzadkiej mutacji genetycznej. Lekarze dodali lek o nazwie lakozamid i regularnie sprawdzali jego stężenie we krwi, aby dostosować dawkę. Chociaż lakozamid nie jest zarejestrowany dla noworodków, okazał się bezpieczny i dobrze tolerowany, ale wymagał wyższej dawki niż zwykle się stosuje.
Oryginalny abstract (angielski)
BACKGROUND: Lacosamide is registered for the treatment of (partial-onset) seizures in adults and children > 2 years of age, with a recommended maximum dose of 12 mg kg-1 in two doses. It is generally well tolerated. The use of lacosamide in neonates is off-label. We present the first case of a neonatal patient with refractory epilepsy who was started on lacosamide with monitoring of serial serum levels. CASE PRESENTATION: We present a case of a prematurely (33 weeks) born Dutch, male neonate with refractory seizures despite multiple anti-epileptic drugs due to a de novo SCN2A mutation. Lacosamide was added, and serial serum trough levels were measured to optimize the dose. Based on the available literature, the dose needed to achieve a therapeutic serum trough level in our patient was much higher than expected, with a dose of 22 mg kg-1 in 4 doses. No side effects were observed. CONCLUSION: In specific cases in the neonatal population, lacosamide is safe and well tolerated and should be considered as a treatment option under strict surveillance of serum trough levels and cardiac monitoring. Higher doses might be needed to achieve a therapeutic serum trough level. Further research is needed to generalize these results and develop adjusted dose guidelines in the neonatal population.