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 recommendations 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 seizures. 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 encephalopathy at the age of one month. Antiseizure medication with few drug interactions, less impact on the neurodevelopmental 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.

中文翻译：

---

拉科酰胺用于治疗接受腹膜透析的肾衰竭儿童的局灶性癫痫

背景

拉科酰胺 (LCM)由于其高耐受性和低药物相互作用，已广泛用于治疗局灶性癫痫发作。与血液透析（HD）患者不同，腹膜透析（PD）患者的药代动力学数据和剂量建议很少。

案例报告

一名患有终末期肾病、接受 PD 的 2 岁女孩出现长时间局灶性癫痫发作。该患者因EYA1基因突变而患有与鳃耳肾综合征相关的先天性肾脏和泌尿道异常。她还在一个月大时出现了复苏后脑病的神经系统后遗症。首选药物相互作用少、对神经发育状态影响较小且可静脉给药的抗癫痫药物。LCM 符合这些标准并且经过精心管理。尽管患者在滴定期间反复出现长时间癫痫发作，但 LCM 可以继续进行，没有任何明显的副作用。LCM 的血液水平线性增加至最佳水平。我们确认了腹膜透析液中 LCM 的排泄。三个月后进行了肾移植，她的癫痫发作得到了很好的控制。

结论

对于接受 PD 的患者来说，LCM 可能是一个有前途的选择。由于PD的去除效果低于HD，因此应密切注意可能的药物过量。