Intravenous lacosamide in status epilepticus: Correlation between loading dose, serum levels, and clinical response

Abstract

High intravenous LCM loading doses (>9mg/kg) were associated with serum levels within the reference interval, there was however no correlation with the clinical response. Prospective studies are needed to evaluate the benefit of increasing the LCM loading dose in SE.

Levetiracetam circulating concentrations and response in status epilepticus

“…Plasma levels may thus be of limited help to predict the availability of treatment at its biological target. Fourthly, the relationship between blood or brain exposure and therapeutic efficacy might display important between-patient pharmacodynamic variability: a similar observation was done for lacosamide in the same clinical setting (Perrenoud et al, 2017). Making a parallel with chronic epilepsy in an outpatient setting, most of the medication effect in responders is usually obtained at low dosage, and increasing doses seem to bring little additional benefit in terms of remission (D'Anto et al, 2017;Poolos et al, 2017) Our response rate to LEV was 34%, lower than previous studies with similar dosages that reported rates of 68.5% in 204 episodes (Yasiry and Shorvon, 2014), or 65.4% in 156 episodes (Trinka and Dobesberger, 2009).…”

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

“…Although LCM is not FDA approved for SE, it has been evaluated in this setting in multiple case series, case reports, and retrospective reviews . The populations studied varied in the types of SE encountered: generalized, convulsive, absence, focal, complex partial, nonconvulsive, refractory, and super refractory (Table ).…”

“…However, doses of concomitant AEDs were not evaluated as confounders in this study, and serum levels were not obtained to correlate with LCM dosing. One retrospective investigation of 40 patients found no correlation between LCM serum levels and clinical response, but doses of greater than 9 mg/kg resulted in serum levels of 10–20 mg/L . Optimal target serum levels in SE have not been defined.…”

“…One retrospective investigation of 40 patients found no correlation between LCM serum levels and clinical response, but doses of greater than 9 mg/kg resulted in serum levels of 10-20 mg/L. 60 Optimal target serum levels in SE have not been defined.…”

Epilepticheskiy Status: Realnost 2019

“…Эффективность применения лакосамида при эпилептическом статусе подтверждается в ряде клинических исследований (33,34,35). В частности, в сравнительном исследовании между вальпроевой кислотой и лакосамидом эпилептический статус удалось купировать в 66,7 % и 69,7 % случаях, соответственно.…”