Abstracts

Rationale: Status epilepticus (SE) is among the most common neurologic emergencies, with a mortality rate of up to 20%. The most important therapeutic goal is fast, effective and well-tolerated cessation of SE. Intravenous (IV) phenytoin/fosphenytoin, phenobarbital or valproate is the current standard treatment after benzodiazepines. Once this first and second line treatment has failed SE is considered refractory (RSE). The reported incidence of RSE is estimated at 25-43%. Lacosamide (LCM) as a new antiepileptic drug has been available as an intravenous solution since 2009 and is often used in treatment of partial seizures. It enhances the slow inactivation of voltage gated sodium channels, which prevents the channel from opening. Though few studies have been done to study LCM as an adjunct in SE it has demonstrated promising preliminary results. Objective: This study aims to assess the efficacy of IV LCM in RSE. Methods: This was a retrospective chart review study. We included 40 patients with RSE between August 2009- June 2013 who were treated with IV LCM at Kaleida Hospitals, Buffalo, NY. A control group consisted of age and sex matched patients with RSE that did not receive LCM. Patients who were on LCM as an outpatient and with etiology of cardiac arrest were excluded from the study. Efficacy was defined as cessation of seizures after starting IV LCM with no need for another antiepileptic drug (AED) or barbiturates such as Pentobarbital. Duration of intubation and hospital stay in each group was also assessed. . Results: Of the 40 patients, 25 were treated with LCM and 15 were treated with other AEDs. Patients' average age was 64.5 (SD=13.5) and 60% were female. The most common etiology in all patients (45%) was intracranial bleed. Nineteen out of 25 patients (76%) used LCM as their last AED without the need of Pentobarbital. Furthermore, 21 out of the 25 LCM users (84%) had their seizures resolved, compared to 60% of other medication users (p=. 090). The mean duration of intubation in the study group was 10.3 versus 11.3 in control group and the mean hospital stay in study group was 20.5 versus 22.5 days in control group (not statistically significant) Conclusions: LCS was effective in resolving RSE in 84% of patients. When comparing this population with patients who received another AED, a trend towards a better outcome was noted for patients who received LCM. Based on the study, we believe that LCM can be an effective add on treatment for RSE and should be considered early in its management. A large prospective study comparing LCM to another AED is suggested.