In children, ESES presents as cognitive/motor deterioration and usually challenging to treat. We present 2 cases: responded dramatically/unexpectedly to lacosamide after having failed traditional treatment.

Case 1:

A 10-year-old boy diagnosed with well controlled ‘benign’ epilepsy since 4 years newly presented with worsening of scholastic performance/day dreaming episodes. Overnight EEG confirmed ESES/ recorded subclinical rolandic seizures. He was receiving oxcarbamazepine, topiramate and phenytoin! Steroids / Clobazam were started/ Oxcarbamazepine withdrawn. He had behavioral changes/ significant weight gain with no substantial improvement. Given weight gain/ behavioral issues valproate/levetiracetam respectively were refused. Oral lacosamide offered. Complete resolution of ESES and interictal discharges with cessation of day dreaming events/ improvement in grades noted. Since 3 years with ongoing EEG/clinical psychological surveillance- doing well with lacosamide monotherapy.

Case 2:

A 12-year old- with spastic dystonic asymmetric cerebral palsy/ controlled epilepsy presented with prolonged dialeptic seizures/ gait worsening/ excessive drooling of saliva/ disorientation. EEG showed ESES. These episodes (lasting several days) responded to short course steroids and optimization of valproate/ clobazam/ leveteriacetam. Remission lasted for weeks-months. However recurrences became refractory. Ketogenic diet was refused. Oral Lacosamide was offered as last ditch. The clinical status and ESES improved to baseline. ESES has not reoccurred for 2 years. Interictal EEG has shown dramatic improvement in epileptiform discharges.

Conclusion: These case reports demonstrate unexpected sustained positive outcomes with lacosamide in epileptic encephalopathy of different etiologies – this may merit further research.