Lacosamide-Induced Dyskinesia in Children With Intractable Epilepsy

Abstract

Lacosamide, an antiepileptic drug prescribed for children with refractory focal epilepsy, is generally well tolerated, with dose-dependent adverse effects. We describe 4 children who developed a movement disorder in conjunction with the initiation and/or uptitration of lacosamide. Three patients developed dyskinesias involving the face or upper extremity whereas the fourth had substantial worsening of chronic facial tics. The patients all had histories suggestive of opercular dysfunction: 3 had seizure semiologies including hypersalivation, facial and upper extremity clonus while the fourth underwent resection of polymicrogyria involving the opercula. Onset, severity, and resolution of dyskinesias correlated with lacosamide dosing. These cases suggest that pediatric patients with dysfunction of the opercular cortex are at increased risk for developing drug-induced dyskinesias on high-dose lacosamide therapy. Practitioners should be aware of this potential side effect and consider weaning lacosamide or video electroencephalography (EEG) for differential diagnosis, particularly in pediatric patients with underlying opercular dysfunction.

Movement Disorders Secondary to Novel Antiseizure Medications in Pediatric Populations: A Systematic Review and Meta-analysis of Risk

“…A recent case series has also demonstrated a dose-dependent relationship between lacosamide administration and dyskinesias of the face and/or upper extremity in children with histories suggestive of opercular dysfunction. 54 Two modern randomized controlled trials of fenfluramine in Dravet syndrome have been reported, though neither reports the incidence of treatment-emergent adverse events occurring in less than 10% of children. 55 , 56 Brivaracetam was approved for use in pediatric populations based on a randomized controlled trial including participants as young as 16 years and data showing similar pharmacologic properties in pediatrics as in adults.…”

Tolerability and Safety of Lacosamide in Neonatal Population

“…2,4 It has been shown to successfully terminate seizures in adults and children, with recent case studies demonstrating efficacy in neonates. 5,6 Its efficacy mixed with tolerable common side effects (occasional dizziness, somnolence, nausea and vomiting, headaches, diplopia, and dyskinesias) 3,7 has made it more popular in recent years. 8 Although many studies have found lacosamide to be a safe medication with mild side effects, 3,[8][9][10][11][12] there are also a handful of case studies that note significant cardiac events, most related to prolongation of the PR interval.…”