The Use of Lacosamide in Refractory Status Epilepticus

Goodwin, Haley; Hinson, Holly E.; Shermock, Kenneth M.; Karanjia, Navaz; Lewin, John J.

doi:10.1007/s12028-010-9501-8

Cited by 62 publications

(56 citation statements)

References 9 publications

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“…This is in contrast to the other studies/case reports discussed here, where patients could have received lacosamide as a first-line AED, and in fact, 20.8 % of the patients in our study did so. Minor adverse events were noted in this trial [22], although only one allergic skin reaction was clearly associated with intravenous lacosamide and three of the nine patients reported angioedema with lacosamide leading to discontinuation in one patient [22]. In the systematic review of case reports and case series in 136 patients with SE, the overall rate of adverse events was low and the most common was mild sedation in 25 cases.…”

Section: Discussionmentioning

confidence: 72%

“…The reasons underlying this lack of response to lacosamide in the Goodwin et al study is unclear, but are likely due to small patient numbers and the use of the agent as at least a third-line therapy in known refractory patients. In the Goodwin trial, the most frequently used regimen of intravenous lacosamide was a 200 mg initial dose, followed by 200 mg every 12 h [22]. This is similar to the dose used in the current trial (400 mg/day for 8 days), perhaps negating the suggestion that patients were under dosed.…”

Section: Discussionmentioning

confidence: 79%

“…In a systematic review of case reports and case series (total n = 136), the overall rate of seizure termination with intravenous lacosamide was 56 % [17]. Conversely, in a retrospective study in nine patients with refractory SE none of the patients achieved seizure termination with intravenous lacosamide [22]. The reasons underlying this lack of response to lacosamide in the Goodwin et al study is unclear, but are likely due to small patient numbers and the use of the agent as at least a third-line therapy in known refractory patients.…”

Section: Discussionmentioning

confidence: 99%

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Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus

et al. 2015

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus

et al. 2015

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“…1 In animal models, its utility to reduce the cumilative seizure time of self-sustaining status epilepticus and hippocampal neuronal damage was shown. 2 In 3 randomized doubleblind, placebo-controlled, multicenter trials in more than 1200 patients, efficiency of LCM was studied and they reported a significant reduction in seizure frequency with doses of 200 to 600 mg/d. [3][4][5] Additionally, as a result of new clinical studies on status epilepticus (SE), LCM remarked compared with other new antiepileptic drugs (AED).…”

Section: Letter To the Editormentioning

confidence: 99%

Significant Improvements of EEG and Clinical Findings With Oral Lacosamide in a Patient With Ring Chromosome 20

Önder

Tezer

2016

Clin EEG Neurosci

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To the Editor, Lacosamide (LCM) was recently approved as an adjunctive therapy for partial-onset seizures with a different mechanism of action that may underly for its effectiveness in intractable epilepsy. 1 In animal models, its utility to reduce the cumilative seizure time of self-sustaining status epilepticus and hippocampal neuronal damage was shown. 2 In 3 randomized doubleblind, placebo-controlled, multicenter trials in more than 1200 patients, efficiency of LCM was studied and they reported a significant reduction in seizure frequency with doses of 200 to 600 mg/d. [3][4][5] Additionally, as a result of new clinical studies on status epilepticus (SE), LCM remarked compared with other new antiepileptic drugs (AED). 2 Here, we present a very rare patient with ring chromosome (R20) who was admitted for refractory epilepsy with frequent secondary generalized seizures (SGTCS) and nonconvulsive status epilepticus (NCSE) episodes. Interestingly, her frequent seizures and EEG findings with NCSE have been significantly improved with an add on treatment of oral lacosamide. Case ReportA 25-year-old woman was hospitalized in our video-EEG monitoring unit 8 years ago due to her refractory seizures and learning problems. Her brother also had learning and behavioral problems whose EEG findings included generalized epileptiform discharges. Our patient had daily complex partial seizures and secondary generalized seizures. Also her interictal EEG showed very frequent generalized epileptiform activities. She was apathic and confused. Despite the usage of lots of AEDs, including carbamazepine, valproic acide, levetiracetam, intravenously or orally, she had frequent seizures, she was confused and her EEG was not recovered. Her brain magnetic resonance imaging was unremarkable. Because of her progressive secondary generalized seizures, learning problems and EEG findings showing NCSE patterns occuring particularly during sleep period, she was investigated for R20. After diagnosis of R20 mosaicism, we decided to vagus nerve stimulation treatment but that was not available because of her social problems.Her family reported daily seizures and she was apathic with frequent epileptiform discharges on EEG at the last follow-up visiting in our outpatient clinic, 7 months ago. Although she has been undertreatment of carbamazepine 600 mg/d, valproic acid 1500 mg/d, levetiracetam 2000 mg/d, and clonazepam 3 g/d, she had 4 to 5 SGTCSs in a day. On neurological examination, she was confused and unable to walk alone. Routine laboratory investigations including full blood count and biochemistry were normal. Serum drug levels for carbamazepine (6 mg/L) and valproic acid (68 µg/mL) were in theraupatic ranges. Routine EEG showed backround activity slowing with 3.5-to 4-Hz waves. Generalized slow and sharp characterized slow waves and 2-to 2.5-Hz spike-wave complexes were reported in anterior parts of hemispheres. These generalized epileptiform discharges appeared for 40 to 60 seconds with not any clinical findings (Figure 1 A and B).Oral LCM wa...

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“…[202122] However, a small case series at Johns Hopkins hospital did not find significant difference in outcomes with use of lacosamide. [23]…”

Section: Introductionmentioning

confidence: 99%

Refractory status epilepticus

Singh

Agarwal

Faulkner

2014

Ann Indian Acad Neurol

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Refractory status epilepticus is a potentially life-threatening medical emergency. It requires early diagnosis and treatment. There is a lack of consensus upon its semantic definition of whether it is status epilepticus that continues despite treatment with benzodiazepine and one antiepileptic medication (AED), i.e., Lorazepam + phenytoin. Others regard refractory status epilepticus as failure of benzodiazepine and 2 antiepileptic medications, i.e., Lorazepam + phenytoin + phenobarb. Up to 30% patients in SE fail to respond to two antiepileptic drugs (AEDs) and 15% continue to have seizure activity despite use of three drugs. Mechanisms that have made the treatment even more challenging are GABA-R that is internalized during status epilepticus and upregulation of multidrug transporter proteins. All patients of refractory status epilepticus require continuous EEG monitoring. There are three main agents used in the treatment of RSE. These include pentobarbital or thiopental, midazolam and propofol. RSE was shown to result in mortality in 35% cases, 39.13% of patients were left with severe neurological deficits, while another 13% had mild neurological deficits.

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The Use of Lacosamide in Refractory Status Epilepticus

Cited by 62 publications

References 9 publications

Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus

Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus

Significant Improvements of EEG and Clinical Findings With Oral Lacosamide in a Patient With Ring Chromosome 20

Refractory status epilepticus

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