Abstracts

Rationale: Pregabalin (PGB) is an approved adjunctive treatment for focal epilepsy in adults. PGB lacks drug-drug interactions, has a favorable safety profile and can be rapidly titrated—attractive characteristics for its use in the neurocritically ill. However, data remain limited regarding its use in the ICU setting. We are sharing our experience with PGB in neurocritically ill patients with refractory seizures. Methods: Charts of eight adult patients admitted to UF Health Shands neurointensive care unit from 1/2018 ̶3/2019 with refractory seizures monitored on continuous electroencephalography (EEG) who received PGB were reviewed retrospectively. Demographics, antiseizure drug (ASD) regimen, and 24h of EEG data pre- and post-PGB were analyzed descriptively. Results: The cohort comprised eight patients (4 females) with mean age of 68.5 years. Mean ICU stay was 9.1 days. Three patients underwent a neurosurgical procedure related to their primary admission diagnosis, and three were admitted with suspicion of seizures. Four were on an ASD on admission, and all received an ASD prior to first seizure captured on EEG. Prior to PGB, patients had failed on average 3 (2-4) other ASDs trials. PGB was dosed 300-400mg/day in 2-4 divided doses, following a load of 75-300mg. PGB lead to a significant reduction on hourly median seizure burden: 5.1 to 1 seizure/h and 5.3 to 0.97 min/h. PGB led to complete seizure cessation in 4 patients within 24h and in 6 out of 8 within 48h of administration. PGB allowed for de-escalation of ASD regimen in 5 out of 8 patients. PGB was well tolerated with the exception of mild sedation in 3 patients, which did not warrant further intervention/neurodiagnostics. Conclusions: In this critically ill cohort with refractory seizures, PGB successfully aborted seizures in 75% of patients. Pregabalin may represent a good alternative to other ASD in this population. Future studies should include prospective pregabalin treatment protocols. Funding: No funding