Neonatal Cardiac Arrest Following Lacosamide Treatment: A Case Report

• Published in: Pediatric neurology 2023-12, Vol.149, p.184-186
• Main Authors: Huberman, Melissa Ann, Mallar, Carolina, Kalika, Paige M.
• Format: Article
• Language: English
• Subjects: Antiseizure Drugs; Cardiac; Lacosamide; Neonatal; Neonatal Seizure; Seizures
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2023.09.004

Lacosamide is an antiepileptic drug with FDA approval for treatment of partial-onset seizures in patients above the age of 1 month. Lacosamide works by selective enhancement of proteins which induce preferential slow promotion of sodium channels to the hyperpolarized inactive state. Lacosamide is generally well tolerated; however, clinical and nonclinical studies have linked its use with cardiac side effects including PR Prolongation and AV block. We present the case of a 3-week-old female neonatal patient born at 25 weeks gestation who developed 2nd degree AV heart block and cardiac arrest after initiating lacosamide therapy. The patient was being treated for neonatal seizure complicated by intraventricular hemorrhage (grade II) and electrolyte disturbances with phenobarbital, levetiracetam, and phenytoin. Prior to addition of lacosamide therapy, the patient had an unremarkable EKG and no known cardiac risk factors for lacosamide. After medication discontinuation, the patient experienced no reoccurring episodes or other cardiac events. Use of lacosamide for neonatal populations is currently under evaluation. To our knowledge, this is the first report of adverse cardiac event (AV block) in the setting of neonatal lacosamide use. Risk of future adverse cardiac events should be evaluated when determining the safety and efficacy of lacosamide in the neonatal population.