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Background <p>Lacosamide is registered for the treatment of (partial-onset) seizures in adults and children &gt; 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.</p> Case presentation <p>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&#xa0;mg&#xa0;kg-1 in 4 doses. No side effects were observed.</p> Conclusion <p>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.</p>

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Therapeutic drug monitoring of lacosamide as add-on treatment in a neonate with therapy-resistant epilepsy due to SCN2A mutation: a case report

  • 期刊论文

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  • 发表日期：

    2026年6月18日

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  • M. Slikkerveer,
  • M. C. Hutten,
  • S. Klinkenberg,
  • A. C. S. Knijnenburg

摘要

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.