Abstracts

Rationale: Status Epilepticus (SE) is a frequently encountered neurological emergency with a high rate of morbidity and mortality. Based on trials from the late 1990s, the gold standard treatment of status epilepticus has become a benzodiazepine followed by first generation anti-epileptic drugs (AED). Lacosamide has fewer side effects and has ease of use compared to older AEDs. However, its efficacy in the termination of status epilepticus lacks evidence which is limited to a small number of case series. Our primary objective was to determine whether LCM is a safe and effective therapeutic option for the treatment of status epilepticus.Methods: Retrospective chart review was carried out in 79 patients admitted for SE between 2011 and 2013 who received intravenous LCM. We gathered baseline characteristics including age, gender, etiology, history of epilepsy, past AEDs if they were on any, type of SE, as well as the order of AEDs given and when SE terminated. Termination of SE was determined clinically or electrographically and was defined by lack of recurrence within 24 hours.Results: Of 79 patients, 49 (62%) were males. The most common type of SE was generalized convulsive seen in 42 (53%) patients. Structural lesions (prior strokes, TBI, metastases) were the most common underlying etiology. LCM was used as a first line agent up to a fifth-line agent to terminate SE. The loading dose of LCM varied from 200-400mg. Of[D1] 79 patients included in the study, 45 (57%) had termination of SE after IV dose of LCM. In this subset of the cohort, termination of SE occurred within the first six hours in 30 patients, between 6-12 hours in 12 patients and between 12-24 hours in 3 patients. Eight of 14 patients (57%) who had LCM as a first-line agent had termination of SE. Eighteen of 26 patients (69%) had termination of SE when LCM was used as a second-line agent. Eleven of 19 patients (58%) who received LCM as third agent had termination of SE. Similarly, 5 out of 14 (35%) and 3 out of 6 (50%) patients showed termination of SE when LCM was used as 4th and 5th agent, respectively. No adverse effects of LCM were reported in our cohort.Conclusions: LCM has been shown in small case reports to be an effective and safe option in the treatment of status epilepticus. In our case series, it was more effective when used earlier in the management cascade of SE. Failure of termination when used later in the treatment regimen may reflect the refractory nature of SE rather than loss of efficacy. The tolerability and ease of accessibility combined with its rapid onset of action in comparison to other new AEDs such as levetiracetam may prove to be of further benefit in the consideration of its use. Further prospective studies are needed to better identify its tolerability and effective dose range.