Abstracts

Rationale: Lacosamide(LCM) is a new antiepileptic drug approved as adjunctive therapy for partial-onset seizures. To date there have been two case reports of use of LCM for successful treatment of status epilepticus. The purpose of this study was to determine the efficacy of LCM in treatment of frequent nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in critically ill patients. Methods: Charts of patients with seizures determined by long-term electroencephalographic (EEG) monitoring were reviewed. Patients who received LCM for acute therapy were reviewed in detail. The patients were considered to be responders if their seizures were terminated with in 24 hrs of initiation of LCM without the addition of an additional antiepileptic agent. Characteristics of subjects whose seizures or NCSE was terminated with LCM were compared to those for whom this drug was not successful. In particular, the etiology, prior use of AED, as well as final outcome was noted. The dosing pattern of LCM, final dosage and adverse effects were recorded as well. Results: A total of 32 patients received LCM for treatment of seizures or history of epilepsy. Of these, 15 patients received LCM for treatment of NCS or NCSE; 9 (60%) of them were responders. LCM was administered in the intravenous form in all except one patient and was administered as the 3rd to 5th agent. The average initial loading dose and total daily dose of LCM was similar in the responders and non responders (311 mg vs. 300 mg). All of the responders were noted to have NCS, while 33% of non responders had NCSE. Duration of seizures was 6.8 hrs for responders vs. 23 hrs for non responders. Etiology was related to primary brain tumor in 5 of the 9 (55%) responders as compared to 1 of the 6 (16%) non responders. The responders were noted to have better clinical outcome (66% vs. 16% discharged home). Most of the patients tolerated the medication without any significant short term adverse effects; one patient was noted to be more aggressive following the addition of LCM. Conclusions: Parental lacosamide appears to be efficacious as add-on for treatment of nonconvulsive seizures and status epilepticus in critically ill patients.