title: Factors influencing response to intravenous lacosamide in emergency situations: LACO-IV study.
abstract: Status epilepticus (SE) and acute repetitive seizures (ARSs) frequently result in emergency visits. Wide variations in response are seen with standard antiepileptic drugs (AEDs). Oral and intravenous (IV) formulations of lacosamide are approved as adjunctive therapy in the treatment of partial-onset seizures in adults and adolescents. The aim of the retrospective multicenter observational study (LACO-IV) was to analyze data from a large cohort of patients with SE or ARSs of varying severity and etiology, who received IV lacosamide in the emergency setting. Patient clinical data were entered into a database; lacosamide use and efficacy and tolerability variables were analyzed. In SE, IV lacosamide tended to be used mainly in nonconvulsive status epilepticus as second- or third-line treatment. The proportion of patients with no seizures when IV lacosamide was the last drug administered was 76.5% (70.9% SE and 83.7% ARSs). The rate of seizure cessation ≤ 24 h after IV lacosamide administration was 57.1% (49.1% SE and 67.4% ARSs). Of the factors analyzed, a shorter latency from seizure onset to IV lacosamide infusion influenced treatment response significantly. A nonsignificant tendency towards a higher response was seen with lacosamide dose >200mg versus ≤ 200 mg. Analysis of response according to mechanism of action showed no significant differences in response to IV lacosamide in patients receiving prior sodium channel blocker (SCB) or non-SCB AEDs in the overall or SE population; however, in ARSs, a tendency towards a higher response was observed in those receiving non-SCB AEDs. The frequency and nature of adverse events observed were in line with those reported in other studies (somnolence being the most frequent). In the absence of randomized prospective controlled studies of IV lacosamide, our observations suggest that IV lacosamide may be a potential alternative for treatment of SE/ARSs when seizures fail to improve with standard AEDs or when AEDs are contraindicated or not recommended.
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: mergarces@gmail.com.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Garcés
authors.affiliation: Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: vevillanuevah@yahoo.es.
authors.forename: Vicente
authors.initials: V
authors.lastname: Villanueva
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. Electronic address: jamauri@telefonica.net.
authors.forename: José Angel
authors.initials: JA
authors.lastname: Mauri
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. Electronic address: anasm98@gmail.com.
authors.forename: Ana
authors.initials: A
authors.lastname: Suller
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. Electronic address: carolariza@hotmail.com.
authors.forename: Carolina
authors.initials: C
authors.lastname: García
authors.affiliation: Complejo Hospitalario Universitario, Santiago, Spain. Electronic address: javieritol@yahoo.com.
authors.forename: Franscisco Javier
authors.initials: FJ
authors.lastname: López González
authors.affiliation: Complejo Hospitalario Universitario, Santiago, Spain. Electronic address: xiana.ro@gmail.com.
authors.forename: Xiana
authors.initials: X
authors.lastname: Rodríguez Osorio
authors.affiliation: Complejo Hospitalario Universitario, Santiago, Spain. Electronic address: gferpaj@hotmail.com.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Fernández Pajarín
authors.affiliation: Hospital Clínico Universitario, Valencia, Spain. Electronic address: annapiera77@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Piera
authors.affiliation: Hospital Clínico Universitario, Valencia, Spain. Electronic address: e_guillamon@hotmail.com.
authors.forename: Edelmira
authors.initials: E
authors.lastname: Guillamón
authors.affiliation: Hospital Clínico Universitario, Valencia, Spain. Electronic address: santafe_mar@gva.es.
authors.forename: Consuelo
authors.initials: C
authors.lastname: Santafé
authors.affiliation: Hospital General Universitario Valencia, Spain. Electronic address: s_castillo_ruiz@yahoo.es.
authors.forename: Ascensión
authors.initials: A
authors.lastname: Castillo
authors.affiliation: Hospital Universitario Dr. Peset, Valencia, Spain. Electronic address: giner_pau@gva.es.
authors.forename: Pau
authors.initials: P
authors.lastname: Giner
authors.affiliation: Hospital Universitario Dr. Peset, Valencia, Spain. Electronic address: netorres84@gmail.com.
authors.forename: Nerea
authors.initials: N
authors.lastname: Torres
authors.affiliation: Hospital Galdakao, Vizcaya, Spain. Electronic address: M.INES.ESCALZACORTINA@osakidetza.net.
authors.forename: Inés
authors.initials: I
authors.lastname: Escalza
authors.affiliation: Hospital General Universitario, Castellón, Spain. Electronic address: ana_delvi@yahoo.es.
authors.forename: Ana
authors.initials: A
authors.lastname: Del Villar
authors.affiliation: Hospital Sur Santa Cruz Tenerife, Spain. Electronic address: carmen.casasola@hospiten.com.
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: García de Casasola
authors.affiliation: Hospital Universitario Arnau de Vilanova, Valencia, Spain. Electronic address: bonet_mac@gva.es.
authors.forename: Macarena
authors.initials: M
authors.lastname: Bonet
authors.affiliation: Hospital NISA Valencia al Mar, Valencia, Spain. Electronic address: enoe@comv.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Noé
authors.affiliation: Hospital Gomez Ulla, Madrid, Spain. Electronic address: nurolmedilla@hotmail.com.
authors.forename: Nuria
authors.initials: N
authors.lastname: Olmedilla
mesh_terms: D000081:Acetamides / Q000008:administration & dosage*; D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D000078334:Lacosamide; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019370:Observation; D011930:Reaction Time / Q000187:drug effects; D013226:Status Epilepticus / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000081:Acetamides; D000927:Anticonvulsants; D000078334:Lacosamide
keywords: Acute repetitive seizures; Emergency setting; Intravenous (IV) lacosamide; Retrospective study; Status epilepticus