Abstracts

Rationale: Lacosamide i.v. formulation is approved for substitution with tablets. We know from the regulatory studies that lacosamide reach the same blood concentration within 15 minutes. When patients leave the epilepsy-monitoring unit, we want to reestablish the antiepileptic drug treatment as soon as possible to avoid further seizures. Earlier on, we used to give lacosamide i.v. but soon learnt that tablets are as effective. Methods: We had the opportunity to perform video EEG monitoring in a patient with a cluster of seizures and observe her after giving lacosamide tablets, as to see how quickly the seizures stopped and the EEG changed back to usual interictal state. Patient history: a 51 year old woman with partial epilepsy since the age of 14 . The epilepsy has been very difficult to treat and she has twice been evaluated for epilepsy surgery but she declined, as MR is normal and intracranial recording would be necessary. She is currently on five antiepileptic drugs together with VNS and ketogenic diet. However, she had never been exposed to lacosamide. The patient was acutely admitted due to clusters of seizures over a couple of days. Results: In the EEG unit, she had seven short seizures of her well-known type within 15 minutes. In between the seizures, she was fully awake and was able to swallow tablets. Lacosamide 400 mg was administered and with EEG and Video still running. The seizures stopped and within 15 minutes the seizure activity disappeared and the EEG showed the usual interictal pattern again. During the seizures she stopped speaking, had eye and head turning to the right and in some cases showed 'chapeau de gendarme' . The ictal EEG showed diffuse electrodecremental response. Ictal and interictal delta activity in the right temporal region and with spreading to the right frontal mesial region. Conclusions: As long as a patient with seizure cluster is conscious enough to swallow tablets, this is the easiest way to administer a bolus dose of lacosamide, much easier an more quick than to establishi an i.v. line. Th oral loading can also be performed in a low-tech environment. Funding: none