Oral pregabalin as an add‐on treatment for status epilepticus

Status epilepticus is characterized by a prolonged, self-sustaining seizure or repeated seizures without return to baseline. The clinical manifestations of status epilepticus in children and adults range from overt generalized convulsions to more subtle behavioral manifestations, including unresponsiveness in the setting of the intensive care unit. Status epilepticus is the most common neurologic emergency of childhood. A large proportion of these episodes are the result of a prolonged febrile seizure or an acute symptomatic etiology. Fortunately, status epilepticus occurs without consequence for many children, but for others, it is correlated with long-term neurologic dysfunction or death. Treatment of status epilepticus should commence promptly upon its recognition, using predefined treatment protocols. The goal of treatment is the rapid termination of the seizure, to minimize the acute and chronic effects of this emergency and to allow for the prompt assessment and management of the underlying precipitant. Currently, the drug class of first choice in the in-hospital and out-of-hospital treatment of status epilepticus is the benzodiazepines, which may need to be quickly followed by a next-line agent, as the efficacy of the benzodiazepines is negatively correlated with seizure duration. Traditionally, these next-line agents have included phenobarbital and phenytoin, but emerging evidence supports the use of intravenous formulations of other antiepileptic drugs. If the first two agents fail, high-dose intravenous midazolam or anesthetic therapy should be rapidly initiated. This paper reviews the current treatment options and strategies for pediatric patients with status epilepticus.

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“…Oxcarbazepine, carbamazepine, rufinamide, felbamate, pregabalin [45,Class IV], and others may also be added by nasogastric tube.…”

Section: Other Oral Antiepileptic Medicationsmentioning

confidence: 99%

Treatment of Pediatric Status Epilepticus

Loddenkemper

Goodkin

2011

Curr Treat Options Neurol

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“…Pregabalin (PGB) is only available as an oral agent, but it is considered as a potential option in treating RSE since it has a good safety profile, can be started at a high dose, does not interact with other AEDs and has good oral bioavailability. A preliminary study by Novy and Rossetti [19] showed that 5/11 patients with RSE demonstrated a clinical response to the addition of PGB after the patients were treated with a benzodiazepine and another AED. PGB has a different mechanism of action than PHT or LEV.…”

Section: Background and Significancementioning

confidence: 99%

Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain Tumors

et al. 2011

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Background There were nearly 700,000 patients in the United States in 2010 living with brain tumor diagnoses. The incidence of seizures in this population is as high as 70% and is historically difficult to control. Approximately 30-40% of brain tumors patients who present with status epilepticus (SE) will not respond to typical therapy consisting of benzodiazepines and phenytoin (PHT), resulting in patients with refractory status epilepticus (RSE). RSE is usually treated with anesthetic doses of propofol or midazolam infusions. This therapy can have significant risk, particularly in patients with cancer. Methods A retrospective chart review was performed on 23 patients with primary or metastatic brain tumors whose SE was treated with intravenous PHT, levetiracetam (LEV), and oral pregabalin (PGB). Results In all the patients under study, PHT or LEV was used as first-line therapy. PGB was typically used as thirdline treatment. The median daily dose of PGB was 375 mg (usually divided BID or TID), and the median daily dose of LEV 3000 mg (usually divided BID). Cessation of SE was seen in 16/23 (70%) after administration of PHT, LEV, and PGB. SE was aborted, on average, 24 h after addition of the third antiepileptic drug. Only one patient in the responder group required intubation. Mortality rate was zero in the responder group. No adverse reactions to this medication regimen were observed.Conclusion Our study suggests that the administration of PHT, LEV, and PGB in brain tumor patients with RSE is safe and highly effective.

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“…Several studies already analyzed the efficacy of newer AEDs in SE (11)(12)(13)(14)(15)(16)(17)(18)(19)(20); however, besides a previous preliminary analysis by our group (20), little is known regarding the evolution over time in AEDs prescription patterns in SE, and its impact on clinical outcome. The aims of this study were to explore the changes in prescription of newer and traditional AEDs in SE treatment over the last decade, and their association with prognosis.…”

Section: Introductionmentioning

confidence: 98%