Intravenous lacosamide in seizure emergencies: Observations from a hospitalized in-patient adult population

Seizure. 2016 Nov:42:20-28. doi: 10.1016/j.seizure.2016.09.004. Epub 2016 Sep 22.

Abstract

Purpose: to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients.

Methods: we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200-400mg and the maintenance dose was 200-400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion.

Results: an acute anti-seizure effect after IV LCM was especially evident when it was first used - (SC) or second line (established SE) treatment. In particular, 87% of SC patients (13/15) and 80% of established SE (8/10) demonstrated response to LCM treatment, while no patients with super-refractory SE (0/8) responded to IV LCM according to our criteria. The loading of IV LCM was well tolerated, with mild adverse effects (2/38 temporary dizziness). In most patients, during and after administration of the loading dose of IV LCM a temporary (30min-1h) sedation was observed. No ECG and laboratory values-changes were documented in any of the patients.

Conclusions: LCM is an effective and well-tolerated treatment when used to treat SC in hospitalized adult patients. As add-on therapy, it may be useful to stop seizure activity in patients with focal SE not responding to first/second-line intravenous AEDs.

Keywords: Hospitalized adult population; Lacosamide; Seizure clusters; Seizure emergencies; Status epilepticus; Video-EEG monitoring.

MeSH terms

  • Acetamides / administration & dosage*
  • Acetamides / adverse effects
  • Administration, Intravenous
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticonvulsants / administration & dosage*
  • Anticonvulsants / adverse effects
  • Brain / diagnostic imaging
  • Brain / physiopathology
  • Electroencephalography
  • Female
  • Hospitalization
  • Humans
  • Inpatients
  • Lacosamide
  • Male
  • Middle Aged
  • Prospective Studies
  • Seizures / diagnostic imaging
  • Seizures / drug therapy*
  • Seizures / physiopathology
  • Status Epilepticus / diagnostic imaging
  • Status Epilepticus / drug therapy*
  • Status Epilepticus / physiopathology
  • Treatment Outcome

Substances

  • Acetamides
  • Anticonvulsants
  • Lacosamide