that has long been the target of many of the older antiepileptic drugs. It is well known that
some seizure phenotypes have specific neuronal membrane or ion channel defects that can
predispose to excessive cortical excitability.4 This will undoubtedly lead to many targeted
treatment approaches to these channelopathies. It is not yet well delineated whether
antiepileptic drugs with actions on distinct ion channels have better response rates when
treating epilepsies associated with channelopathies. On the other hand, it has been
previously shown that some medications that act on sodium channels, such as lamotrigine
and carbamazepine, can worsen seizures associated with Dravet syndrome, a defect of the
SCN1A channel.5,6
Initial studies also found that lacosamide modulates collapsin response mediator protein-2
(CRMP-2), a phosphoprotein involved in axonal outgrowth and neuronal differentiation.7 It is
unclear whether this interaction has an impact on epileptogenesis, as unregulated or
disorganized neuronal connections are hypothesized to be involved in seizure propagation.
This interaction with collapsin response mediator protein-2 also causes concern about
potential adverse effects on the developing brain. This mechanism of action warrants further
investigation, as most recent evidence suggests that lacosamide does not actually bind to
this protein.8
Despite treatment with many of the classic and new antiepileptic drugs, more than 30% of
patients with epilepsy become refractory to current treatments.9 Surgical intervention, vagal
nerve stimulation, and the ketogenic diet can also fail in these patients. New pharmaceutical
approaches for the treatment of seizures are important for these individuals who have failed
other therapies.
Clinical studies have shown that lacosamide has a good response rate in adults with a
favorable side-effect profile.10,11 There is a sparse amount of data that exists on the efficacy of
lacosamide in the pediatric population. The present single-center retrospective study reviews
the efficacy and tolerability of lacosamide as adjunctive treatment or monotherapy in children
with epilepsy.