Usefulness of intravenous lacosamide in status epilepticus

Abstract

Lacosamide (LCM) is a treatment option for status epilepticus (SE) described in several series. We therefore proposed to describe its use in status epilepticus patients in our hospital. All patients admitted to our hospital for SE from September 2010 to April 2012 were evaluated. We collected related variables including the type of SE, etiology, antiepileptic drugs (AEDs) used, loading dose of AEDs, cessation of SE after AEDs, ICU admission and mortality. In those patients receiving LCM, we reviewed the infusion rate and time to response. We compared patients receiving LCM with patients in whom it was not used. This was a retrospective and uncontrolled study. A total of 92 patients were included; 67.7 % of SE patients who received LCM responded to treatment. The vast majority of the patients presented non-convulsive and motor focal SE. When we selected patients to receive four or more AEDs, the LCM efficacy was 55.6 %, a very similar result compared to when it was not used. Subsequently, we analyzed the sample regarding the AED administered as the second or third line of treatment, and the responder rate was significantly higher when LCM was used (84.6 vs. 47.8 %, p 0.041). After an adjusted regression analysis, the use of LCM was independently associated with cessation of SE. The total percentage of undesirable effects was very low (12 %), and they were all mild. No relationship was found between a specific etiology and better response. LCM is a useful drug that represents an alternative in the treatment of non-convulsive or focal motor SE. Its efficacy might be more important when it is administered as a second or third option after benzodiazepines. A randomized trial is required to confirm these results.

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 ).…”

“…In a retrospective single‐center study of 92 SE patients, 31 received IV LCM . Most patients in the LCM group had nonconvulsive or motor focal SE.…”

Systemic complications of status epilepticus — An update

“…While valproic acid and levetiracetam are well tolerated in hemodynamically tenuous patients, valproic acid has the theoretical risks of platelet and clotting dysfunction and hyperammonemia in predisposed patients, and levetiracetam may be sedating in the high doses required in status epilepticus. Lacosamide may cause PR prolongation but in a series of 92 patients with primarily nonconvulsive or focal motor status epilepticus treated with lacosamide, only 2 experienced asymptomatic PR prolongation, and 2 experienced dizziness [22]. Fosphenytoin, while commonly used as a second-line agent in status epilepticus, is less well tolerated primarily because of hypotension.…”

Lacosamide in status epilepticus: Systematic review of current evidence

“…Santamarina et al retrospectively analyzed 91 cases of SE in a single center in Barcelona. Of these, 31 patients received LCM.…”