ArticleJournal of medical case reports2026
Therapeutic drug monitoring of lacosamide as add-on treatment in a neonate with therapy-resistant epilepsy due to SCN2A mutation: a case report.
Article in Journal of medical case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundLacosamide 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.
conclusionIn 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.
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