Abstracts

Rationale: Lacosamide is a novel AED approved for the treatment of partial epilepsy. Anecdotal reports have suggested efficacy in patients with status epilepticus or acute repetitive seizures though such cases are relatively few in the published literature.Methods: We report three patients who presented with either acute repetitive seizures or with NCSE who were refractory to conventional therapy but responded rapidly to intravenous lacosamide. Continuous video-EEG monitoring data was reviewed and correlated with the response to lacosamide.Results: A 60 year old man with left frontotemporal anaplastic astrocytoma was admitted for ictal aphasia refractory to appropriate doses of valproate, pregabalin and levetiracetam. EEG showed almost continuous left hemispheric electrographic seizures (Figure 1). After receiving 100 mg of intravenous lacosamide and initiation of maintenance therapy there was resolution of aphasia and the ictal pattern over a 24 hour period. A 56 yr old man with left intraparenchymal and subarachnoid hemorrhage developed worsening confusion followed by a GTC seizure. He was noted to have continuous electrographic seizures emanating from the left hemisphere and were associated with persistent confusion and orofacial automatisms. After failing to improve with adequate doses of phenytoin, 300 mg intravenous lacosamide was given as a load followed by 100 mg twice daily. Within twelve hours by EEG criteria his seizure frequency declined to < 75% and by 24 hours resolved completely. A 84 year old man with history of right hemispheric stroke and mild cognitive impairment was admitted for confusional episodes. He was noted to have electrographic seizures originating from either hemispheres associated with staring and dysphasia. After failing to respond to appropriate doses of intravenous Levetiracetam, to avoid sedation intravenous Lacosamide was introduced at 100 mg twice daily that resulted in rapid reduction of seizure frequency and eventually complete resolution of seizures within 36 hours. Subsequent inadvertent discontinuation of lacosamide as an outpatient resulted in recurrence of seizures, however, reintroduction of Lacosamide resulted in excellent seizure control. Conclusions: Based on our results, in patients with refractory acute repetitive seizures or non-convulsive status epilepticus lacosamide appears to be a very effective and safe alternative. Further studies are needed to elucidate the role of lacosamide as an adjunctive medication in patients with status epilepticus.