Newer Antiepileptics In Pediatrics-  Eslicarbazepine And Lacosamide

Generation Of Antiepileptics

First Generation Antiepileptics

These medications are classified as first-generation antiepileptics: bromide, phenobarbital, phenytoin, primidone, sulthiame, carbamazepine, and valproate. Primidone was the first anti-epileptic medication to be identified and used in a clinical setting. Bromide derivatives were the first, but they are no longer in use.

Phenobarbital was developed in the 1920s, following World battle I; additional antiepileptics followed suit. The first anti-epileptic had been clinically used in 1857, when India was waging its first battle of independence.

Second Generation Antiepileptics

Clobazam, Vigabatrin, Oxcarbazepine, Lamotrigine, Gabapentin, Felbamate, Topiramate, Tiagabine, Levetiracetam, Pregabalin, Zonisamide, Stiripentol, and Rufinamide are examples of second generation antiepileptics.

In private treatment, levetiracetam and lamotrigine are often used in numerous pediatric epilepsies; carbamazepine is the preferred medication, followed by oxcarbazepine.

Third Generation Antiepileptics

Third-generation antiepileptics include the following individual drugs:

• Eslicarbazepine (acetate)
• Lacosamide
• Retigabine/Ezogabine
• Perampanel
• Everolimus
• Brivaracetam
• Cannabidiol

Eslicarbazepine (ESL)      

 It is available as eslicarbazepine acetate when used in clinical settings.  It is a member of the carboxamide family within the chemical group or family.  Two medications from the prior generation are part of the carboxamide family. Three drug generations exist: carbamazepine (first generation), oxcarbazepine (second generation), and eslicarbazepine (third generation).

As a result, they are all related to the carboxamide family.
Mode of action: As with the other two medications, it works by obstructing voltage-gated sodium channels.  There will be no parental form available; it will be administered orally.

Clinical indications for eslicarbazepine FDA approved pediatric use of eslicarbazepine in 2017;  Works well as adjuvant therapy for focal seizures in children four years of age or older.

Dosage

The medication is started once daily at a dose of 10–20 mg/kg.
Its once-daily dosing results in improved compliance.
To reach the maintenance level, the dosage was gradually raised over a period of one to two weeks. Once daily, the maintenance dose is 20–60 mg/kg.

Adverse effects

In 80% of cases, they are present and typically modest. These consist of vertigo, blurred vision, diplopia, headache, nausea, vomiting, and dizziness.According to the majority of these trials, the medication is generally well-tolerated, and any side effects are usually related to those of the older generation of medications in the same class. They have a lot of negative effects and are not evident. They usually get better, even if they are there when therapy first starts.

Major Advantages

 Dosage once daily.  If administered once day, compliance will increase.  The medicine is incredibly well-tolerated.  Interactions with other medications in the same class are negligible or nonexistent.  Due to the fact that it is an adjuvant medication. Therefore, there is no minimum interaction between the other anti-epileptic medications and any other medication the patient may be taking.  Agranulocytosis is not observed.

Let's say a patient is under control and responding to carbamazepine; if the patient experiences agranulocytosis, eslicarbazepine is the recommended medication substitution.
No hyponatremia akin to that caused by oxcarbazepine
This medication is well tolerated; no behavioral or cognitive side effects are observed.

Also Read: Rett Syndrome- Clinical Features And Management

Lacosamide (LCM)

Chemical Group Family

One medication that is a member of the functionalized amino acid family is lacosamide.A large number of amino acid compounds with possible anti-seizure and anti-epileptic effects were developed in the late 1980s and early 2000s. Lacosamide was the only one of them to reach the market and receive official approval. It is a derivative of an amino acid to which several functional groups have been added.

Mechanism of Action

The selective delayed inactivation of voltage-gated sodium channels is improved by lacosamide; rapid inactivation is unaffected. Because only slow inactivation is improved, it stops the spread of seizure control without affecting normal CNS transmission. Any medication that inhibits both will also impact normal CNS conduction to some extent. It is marginally more selective because it will only accelerate the voltage-limited sodium channels' gradual inactivation.

Route

It can be given orally and parenterally (IV).

Clinical Indication

 The FDA authorized it in 2017.The fact that lacosamide can be used as adjuvant therapy or monotherapy distinguishes it from ESL.When treating focal seizures in patients who are at least four years old, it can be helpful with or without secondary generalization.

Dosage  

 It is not administered once day like ESL, the previous medication, was.  Give the patient two divided doses of 2 mg/kg each day to begin.  Increases gradually; the maintenance dose is 7-8 mg/kg given twice a day in divided doses.

Adverse Effects

 There aren't many negative effects.  The dosage range for them is 30% to 60%.  These consist of headaches, nausea, vomiting, and dizziness.  In 4–7% of patients, they can result in alterations in cognition or memory, and in 9.5% of patients, depression.

Major advantages

The tolerability of it is rather good.  There are no interactions with lacosamide.  There is an IV form in addition to the oral one.  Above the age of four, it may play a part in Refractory status epilepticus in the future.

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Hope you found this blog helpful for your NEET SS Pediatrics Neurology Preparation. For more informative and interesting posts like these, keep reading PrepLadder’s blogs.