Abstracts

Rationale: Presence of seizures in patients with cerebrovascular disease is associated with worse outcome and poor quality of life. Recurrent or prolonged seizures increase mortality and imply emergency care, aiming to reduce cerebral damage and fatal outcome. New intravenous medications are promising and now available; however, data on specific subgroups, such as focal epilepsy due to cerebrovascular disease, are scarce. The aim of this study is to assess efficacy and safety profile of intravenous lacosamide in adult patients admitted to the ER diagnosed as status epilepticus due to cerebrovascular disease, refractory to conventional first and second line therapy. Methods: We prospectively studied adult patients admitted to the emergency room, diagnosed as status epilepticus due to cerebrovascular disease (either early - 14 days), from January to December 2017. The inclusion criteria were adult patients, focal status epilepticus, concordant cerebrovascular aetiology and refractoriness to first line (benzodiazepines) or second line (phenytoin, phenobarbital or valproate) treatment. Patients were administered intravenous lacosamide as an add-on therapy. During the infusion and 6 hours following the infusion, multiparameter non-invasive monitoring and neurologic monitoring were performed. Electrocardiogram, laboratorial exams, neuroimaging and EEG were also performed. The main outcomes were seizure control (responder or non-responder) and safety. Results: We assessed 11 patients, 4 (36%) male gender, median age 70 years. Ischaemic stroke was prevalent over haemorrhagic (n=9, 81%; vs n=2, 19%), with a predominant involvement of anterior circulation (n=8, 73%). Sixty three per cent of the patients had late seizures. Ten patients (91%) were classified as responders to the treatment with intravenous lacosamide, from which 5 were partial responders, showing a good seizure control and improvement in awareness. Five patients were classified as total responders, with a complete cessation of the seizures. One patient had no benefit with the treatment. Severe adverse reactions weren’t reported, neither during nor after the infusion. Two patients had transitory itch during the infusion of the medication. No skin reaction (such as skin rash), haemodynamic instability, electrocardiogram or blood test disturbance were seen. Conclusions: This is a preliminary pilot study that points add-on intravenous lacosamide as a safe and effective option to status epilepticus refractory to first and second line treatment. Further studies including larger amount of patients, in a randomized and controlled design are needed to add greater strength to this data. Funding: None