title: Rapid loading of intravenous lacosamide: efficacy and practicability during presurgical video-EEG monitoring.
abstract: OBJECTIVE
  This study investigates immediate efficacy and safety of intravenous application of de novo lacosamide (LCM) as add-on therapy in patients with pharmacoresistant focal epilepsy.
  
  
  METHODS
  During presurgical video-electroencephalography (EEG) monitoring, 17 adult inpatients received LCM infusion (200 mg every 12 h for 2-3 days) followed by oral formulation with the same regimen. Before and after intravenous application of LCM, seizures and interictal epileptiform discharges (IEDs) recorded with continuous video-EEG monitoring were analyzed, and an assessment of adverse events (AEs) was performed daily. To evaluate the midterm tolerability and efficacy, follow-up visits were conducted 1 and 3 months after discharge from hospital.
  
  
  RESULTS
  In the acute phase, intravenous initiation of LCM was well tolerated with few mild or moderate AEs (3 of 17, 17.6%). A significant reduction of seizure frequency in the treatment phase as compared to mean seizure frequency in the 2-day baseline phase was achieved (p < 0.05 for the first treatment day, and p < 0.005 for the second treatment day). On the first treatment day, 61.5% of the patients were seizure free, and 84.6% on the second treatment day. IED reduction after intravenous application of LCM was not significant. After 1 month, the 50% responder rate was 46.6% and after the 3-month period, 42.8%.
  
  
  CONCLUSIONS
  Our data suggest that rapid intravenous initiation of de novo LCM is safe and may protect against seizures in a rapid and midterm time window.
authors.affiliation: Department of Neurology, University of Magdeburg, Magdeburg, Germany            Neurological Clinic, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Li
authors.forename: Hermann
authors.initials: H
authors.lastname: Stefan
authors.forename: Julia
authors.initials: J
authors.lastname: Matzen
authors.forename: Stefan
authors.initials: S
authors.lastname: Rampp
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Heinze
authors.forename: Friedhelm C
authors.initials: FC
authors.lastname: Schmitt
mesh_terms: D000081:Acetamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000284:Administration, Oral; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D000078334:Lacosamide; D008297:Male; D016896:Treatment Outcome
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide