Abstracts

Rationale: Seizure management is a significant issue in the care of critically ill patients. A significant proportion of patients in the intensive care unit (ICU) suffer from seizures which can directly impact morbidity and mortality. The clinician is challenged with choosing the safest and most efficacious method of seizure treatment. Although traditional anti-epileptic drugs (AEDs) are effective, they are often associated with adverse events and drug interactions. Lacosamide (LCM) is a new AED which is available in IV form and has not been shown to have any significant adverse effects or drug interactions. However, the safety and efficacy of lacosamide in critically ill patients has not been evaluated. Methods: Critically ill patients in an ICU at Emory University Hospital who received LCM from April 1, 2009 to February 1, 2010 were retrospectively reviewed. Baseline demographic data, admission diagnosis, treatment indication, LCM dose and concurrent AEDs were recorded. Outcome measures were time to complete seizure cessation or 50% decrease in seizure frequency for patients being treated for status epilepticus or incidence of seizure recurrence for patients who received LCM for treatment of isolated seizures or following resolution of status epilepticus. Adverse reactions assessed included hypotension, hypoventilation, cardiac arrythmias, unexplained fever, elevated creatinine and elevated liver function tests (LFTs). Results: 14 patients with 15 different admissions to the ICU were included in the study, with a mean age of 54.7 years. LCM was administered for treatment of ongoing status epilepticus in 7/15 patients and for either treatment of isolated seizures or following resolution of status epilepticus in the remaining 8. The most common loading dose of LCM was 200 mg while the most common maintenance dose was 400 mg/day. 14/15 patients continued to take LCM at discharge. 14/15 underwent continuous EEG monitoring for seizure detection. Complete seizure cessation was achieved in 3/7 of the patients that received LCM for treatment of status epilepticus while the other 4 patients experienced at least a 50% decrease in seizure frequency. 7/8 patients who received LCM for treatment of isolated seizures or following resolution of status epilepticus remained seizure free. LCM was the last adjunctive AED introduced in 13/15 patients. Within one hour of LCM administration, 2/15 experienced a decline in systolic blood pressure (>20 mm Hg) while one patient experienced a prolonged episode of bradycardia. One patient had elevation of liver function tests which led to discontinuation of LCM. No other adverse reactions were noted. Conclusions: Lacosamide appears to be a safe and effective alternative for treatment of seizures in critically ill patients. Further studies are needed in larger series of patients to explore the correlation and clinical relevance of the episodes of hypotension, bradycardia and elevation in liver function tests that were seen in a very small minority of patients in our series.