Abstracts

Rationale: At the completion of inpatient epilepsy assessment, the introduction of previously untrialed AEDs offer a possible elimination of a patient's seizures. The ability to initiate therapy intravenously provides the possibility of providing therapeutic levels and not restarting previously unsuccessful medications. We have been administering intravenous lacosamide at the conclusion of monitoring assessments and discharging patients the same day on a full dose of lacosamide without reinitiating prior medications and wished to review the success of that strategy. Methods: Patients were identified who had received any dose of intravenous lacosamide using our EMR (EPIC). We have collected these admissions from May of 2011 though May of 2014. We reviewed the nature of when administered and identified whether in follow up outpatient care lacosamide was still among the patient's medications. We collected weights and any lacosamide levels provided after the initial IV dose was given. Results: We identified 84 patient who received IV lacosamide. We identified 39 of these received doses as replacement for oral doses given prior to hospitalization (Due to surgery, illness, impaired swallow). IV lacosamide as initial therapy was given to 45 patients. IV lacosamide following video EEG monitoring occurred in 32 patients and an intital dose of lacosamide in status epilepticus occurred in 13 patients. Lacosamide levels were obtained in 16 patients associated with the first 200 mg IV dose. Levels varied from 0 to 12.1. Four levels of zero were investigated and the time of the sample acquisition indicated they were obtained prior to and not following the first dose. The 12 levels averaged 7.09 mg%. The dose per kilogram varied from 2.13 to 3.53 mg(mean 2.66). Illustration 1 shows the lack of a relationship between initial mg/kg dose and level. At first follow up visit four subjects were not prescribed lacosamide (3 from status epilepticus group and 1 reporting it too expensive). The remaining 41 patients received additional prescriptions at follow up to continue lacosamide as monotherapy. Conclusions: We found that IV lacosamide initiation as monotherapy following inpatient Video EEG monitoring possible and produced therapeutic blood concentrations. 41 of 45 patients receiving lacosamide as initial IV therapy continued lacosamide after discharge. We found no clear correlation between initial milligram/kilogram dose and blood concentrations. Our results are limited by our small sample and undefined timing of the post-lacosamide administration level sampling. These initial results are encouraging and suggest further evaluation is warranted.