Use of lacosamide for focal epilepsy in a child with kidney failure undergoing peritoneal dialysis

Background: Lacosamide (LCM) has become commonly used for focal onset seizures due to its high tolerability and low drug interactions. Unlike patients on hemodialysis (HD), pharmacokinetic data and dosing recom-mendations for patients undergoing peritoneal dialysis (PD) are scant. Case report: A 2-year-old girl with end-stage kidney disease undergoing PD suffered prolonged focal onset sei-zures. The patient had congenital anomalies of the kidney and urinary tract associated with branchio-oto-renal syndrome due to an EYA1 gene mutation. She also had neurological sequelae from post-resuscitation encepha-lopathy at the age of one month. Antiseizure medication with few drug interactions, less impact on the neuro-developmental state and possibility of intravenous administration was preferred. LCM met those criteria and was carefully administered. Although the patient had recurrent prolonged seizures during the titration periods, LCM could be continued without any apparent side effects. The blood levels of LCM increased linearly to the optimal level. We confirmed excretion of LCM in the PD fluid. Kidney transplantation was done three months after and her seizures were well controlled. Conclusions: LCM might be a promising option for patients undergoing PD. Due to the lower removal efficacy in PD compared with in HD, close attention should be paid to possible drug excess.