The use of lacosamide in refractory status epilepticus.
BACKGROUND
Case reports suggest lacosamide may have a role in status epilepticus (SE). The purpose of this case series is to describe the use of lacosamide in refractory SE (RSE) at our institution.


METHODS
Observational study of all patients admitted to the neurosciences intensive care unit with RSE who received at least one dose of lacosamide from October 2009 to September 2010.


RESULTS
Nine patients received lacosamide after failure of at least two other agents. Lacosamide was started a median of 2 days (range: 0-14 days) after the onset of SE. The most frequently used dosing regimen was an initial intravenous dose of 200 mg followed by 200 mg every 12 h. Most patients had received 3 (range: 2-5) AEDs prior to lacosamide. Levetiracetam was used prior to lacosamide in all cases. No patients evaluated responded to lacosamide according to our predefined criteria. One patient developed angioedema after receiving two doses; another patient developed angioedema where timing in relation to the lacosamide was unclear. Care was withdrawn in three of the nine patients for reasons unrelated to lacosamide. Lacosamide was continued at discharge on all surviving patients except in one case of angioedema.


CONCLUSIONS
This is the largest case series to date describing the use of lacosamide in patients with RSE. Despite the novel mechanism of action, we observed no evidence that lacosamide is effective in RSE; however, our sample size was small. Further study is needed to determine the role of lacosamide in SE, especially early in the treatment course.
Johns Hopkins Hospital, Baltimore, MD, USA. hgoodwi3@jhmi.edu
Haley
H
Goodwin
Holly E
HE
Hinson
Kenneth M
KM
Shermock
Navaz
N
Karanjia
John J
JJ
Lewin
D000081:Acetamides / Q000009:adverse effects / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000799:Angioedema / Q000139:chemically induced; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000209:etiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D000078334:Lacosamide; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D013226:Status Epilepticus / Q000188:drug therapy*
D000081:Acetamides; D000927:Anticonvulsants; D000077287:Levetiracetam; D000078334:Lacosamide; D010889:Piracetam
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