Abstracts

Rationale: The treatment of refractory status epilepticus (RSE) or seizure clusters remains empirical because of the lack of evidence-based data. The place of new antiepileptic drugs (AEDs) remains largely unknown. Lacosamide (LCM) is a new AED available in intravenous (IV) form with a good safety profile. Small series suggested that it might be useful in RSE. However, the relationship between dose, efficacy and safety has not been studied. We report here our experience with IV LCM, comparing 2 IV initial doses, 200 and 400 mg. Methods: We retrospectively reviewed the charts of all consecutive patients who received IV LCM for status epilepticus or seizure clusters between October 2010 and June 2012. The first patients received an IV load of 200 mg of LCM, followed 12 hours later by another dose of 200 mg (group 1). Due to poor initial results with this dosage, we decided to increase the loading dose to 400 mg of LCM followed by 200 mg 12 hours later (group 2). Seizure cessation after LCM, seizure cessation after another AED treatment, and mortality were studied. Continuous video EEG monitoring was used in all patients. Results: Group 1 included 11 patients (mean age 51; range 32-74). Six patients were in non convulsive status epilepticus (NCSE), 3 were in post convulsive NCSE, and 2 had seizure clusters. LCM was used in third line in 5 patients, fourth in 4, fifth in 1 and sixth in 1. Intravenous LCM was the last drug added in 2 patients (18%). Six patients needed further AEDs to stop seizing; in 1 patient, seizure cluster worsened and 2 patients died uncontrolled. One patient with renal failure developed confusion and myoclonus, which disappeared after LCM dose reduction. Group 2 included 12 patients (mean age 56; range 17-84). Eight patients were in NCSE, 2 were in post convulsive NCSE, 1 was in convulsive status epilepticus and 1 had seizure cluster. LCM was used in second line in 1 patient, third in 1, fourth in 7, and fifth in 3. LCM was the last drug added in 6 patients (50%). Two patients needed another AED treatment to stop seizing, and 4 patients died uncontrolled. No adverse event occurred. Conclusions: In this small retrospective study, an initial dose of 400 mg of IV LCM seemed to be superior to 200 mg, stopping RSE or seizure clusters in 50% of the patients. It was not associated with a higher rate of identifiable serious adverse events, including cardiac arrhythmia. This study also further suggests that LCM should be considered for the treatment of RSE and seizure clusters. Further prospective studies are needed to confirm these findings and define the place of LCM in the therapeutic algorithm of SE.