Journal of Neurology

, Volume 260, Issue 12, pp 3122–3128

Usefulness of intravenous lacosamide in status epilepticus

  • Estevo Santamarina
  • Manuel Toledo
  • Maria Sueiras
  • Miquel Raspall
  • Nadim Ailouti
  • Elena Lainez
  • Isabel Porta
  • R. de Gracia
  • Manuel Quintana
  • Javier Alvarez-Sabín
  • Xavier Salas Puig
Original Communication

Abstract

Lacosamide (LCM) is a treatment option for status epilepticus (SE) described in several series. We therefore proposed to describe its use in status epilepticus patients in our hospital. All patients admitted to our hospital for SE from September 2010 to April 2012 were evaluated. We collected related variables including the type of SE, etiology, antiepileptic drugs (AEDs) used, loading dose of AEDs, cessation of SE after AEDs, ICU admission and mortality. In those patients receiving LCM, we reviewed the infusion rate and time to response. We compared patients receiving LCM with patients in whom it was not used. This was a retrospective and uncontrolled study. A total of 92 patients were included; 67.7 % of SE patients who received LCM responded to treatment. The vast majority of the patients presented non-convulsive and motor focal SE. When we selected patients to receive four or more AEDs, the LCM efficacy was 55.6 %, a very similar result compared to when it was not used. Subsequently, we analyzed the sample regarding the AED administered as the second or third line of treatment, and the responder rate was significantly higher when LCM was used (84.6 vs. 47.8 %, p 0.041). After an adjusted regression analysis, the use of LCM was independently associated with cessation of SE. The total percentage of undesirable effects was very low (12 %), and they were all mild. No relationship was found between a specific etiology and better response. LCM is a useful drug that represents an alternative in the treatment of non-convulsive or focal motor SE. Its efficacy might be more important when it is administered as a second or third option after benzodiazepines. A randomized trial is required to confirm these results.

Keywords

Status epilepticus Lacosamide 

References

  1. 1.
    Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE, Mamdami MB (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339:792–798PubMedCrossRefGoogle Scholar
  2. 2.
    Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, Gottwald MD, O’Neil N, Neuhaus JM, Segal MR, Lowenstein DH (2001) A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345:631–637PubMedCrossRefGoogle Scholar
  3. 3.
    Misra UK, Kalita J, Patel R (2006) Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology 67:340–342PubMedCrossRefGoogle Scholar
  4. 4.
    Shorvon S, Baulac M, Cross H, Trinka E, Walker M, Task-Force on Status Epilepticus of the ILAE Commission for European Affairs (2008) The drug treatment of status epilepticus in Europe: consensus document from a Workshop at the first London Colloquium on Status Epilepticus. Epilepsia 49:1277–1285PubMedCrossRefGoogle Scholar
  5. 5.
    Trinka E, Shorvon S (2009) The proceedings of the Innsbruck Colloquium on Status Epilepticus. Epilepsia 50(Suppl. 12):1–2PubMedCrossRefGoogle Scholar
  6. 6.
    Trinka E, Dobesberger J (2009) New treatment options in status epilepticus: a critical review on intravenous levetiracetam. Ther Adv Neurol Disord 2:79–91PubMedCrossRefGoogle Scholar
  7. 7.
    Möddel G, Bunten S, Dovis C, Kovac S, Dogan M, Fischera M, Dziewas R, Schäbitz WR, Evers S, Happe S (2009) Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus. J Neurol Neurosurg Psychiatry 80:689–692PubMedCrossRefGoogle Scholar
  8. 8.
    Meierkord H, Boon P, Engelsen B, Gçcke K, Shorvon S, Tinuper P, Holtkamp M, European Federation of Neurological Societies (2010) EFNS guideline on the management of status epilepticus in adults. Eur J Neurol 17:348–355PubMedCrossRefGoogle Scholar
  9. 9.
    Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF (2002) Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 59:205–210PubMedCrossRefGoogle Scholar
  10. 10.
    Prasad A, Worrall BB, Bertram EH, Bleck TP (2001) Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia 42:380–386PubMedCrossRefGoogle Scholar
  11. 11.
    Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA (2001) Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 57:1036–1042PubMedCrossRefGoogle Scholar
  12. 12.
    Claassen J, Hirsch LJ, Emerson RG, Mayer SA (2002) Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 43:146–153PubMedCrossRefGoogle Scholar
  13. 13.
    Holtkamp M, Masuhr F, Harms L, Einhäupl KM, Meierkord H, Buchheim K (2003) The management of refractory generalised convulsive and complex partial status epilepticus in three European countries: a survey among epileptologists and critical care neurologists. J Neurol Neurosurg Psychiatry 74(8):1095–1099PubMedCrossRefGoogle Scholar
  14. 14.
    Shorvon S, Ferlisi M (2012) The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 135:2314–2328PubMedCrossRefGoogle Scholar
  15. 15.
    Johannessen Landmark C, Patsalos PN (2010) Drug interactions involving the new second- and third-generation antiepileptic drugs. Expert Rev Neurother 10:119–140PubMedCrossRefGoogle Scholar
  16. 16.
    Chung S, Sperling MR, Biton V, Krauss G, Hebert D, Rudd GD, Doty P, SP754 Study Group (2010) Lacosamide as adjuntive therapy for partial-onset seizures: a randomized controlled trial. Epilepsia 51(6):958–967PubMedCrossRefGoogle Scholar
  17. 17.
    Höfler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka E (2011) Intravenous lacosamide in status epilepticus and seizure clusters. Epilepsia 52:e148–e152PubMedCrossRefGoogle Scholar
  18. 18.
    Kellinghaus C, Berning S, Immisch I, Larch J, Rosenow F, Rossetti AO, Tilz C, Trinka E (2011) Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand 123:137–141PubMedCrossRefGoogle Scholar
  19. 19.
    Parkerson KA, Reinsberger C, Chou SH, Dworetzky BA, Lee JW (2011) Lacosamide in the treatment of acute recurrent seizures and periodic epileptiform patterns in critically ill patients. Epilepsy Behav 20:48–51PubMedCrossRefGoogle Scholar
  20. 20.
    Koubeissi MZ, Mayor CL, Estephan B, Rashid S, Azar NJ (2011) Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus. Acta Neurol Scand 123:132–146CrossRefGoogle Scholar
  21. 21.
    Albers JM, Möddel G, Dittrich R, Steidl C, Suntrup S, Ringelstein EB, Dziewas R (2011) Intravenous lacosamide—an effective add-on treatment of refractory status epilepticus. Seizure 20:428–430PubMedCrossRefGoogle Scholar
  22. 22.
    Miró J, Toledo M, Santamarina E, Ricciardi AC, Villanueva V, Pato A, Ruiz J, Juvany R, Falip M (2013) Efficacy of intravenous lacosamide as an add-on treatment in refractory status epilepticus: a multicentric prospective study. Seizure 22(1):77–79PubMedCrossRefGoogle Scholar
  23. 23.
    Kellinghaus C, Stögbauer F (2012) Treatment of status epilepticus in a large community hospital. Epilepsy Behav 23(3):235–240PubMedCrossRefGoogle Scholar
  24. 24.
    Sutter R, Kaplan PW (2012) Electroencephalographic criteria for nonconvulsive status epilepticus: synopsis and comprehensive survey. Epilepsia 53(Suppl 3):1–51PubMedCrossRefGoogle Scholar
  25. 25.
    Chang AK, Shinnar S (2011) Nonconvulsive status epilepticus. Emerg Med Clin North Am 29(1):65–72PubMedCrossRefGoogle Scholar
  26. 26.
    Goodwin H, Hinston HE, Shermock KM, Karanjia N, Lewin JJ 3rd (2011) The use of lacosamide in refractory status epilepticus. Neurocrit Care 14:348–353PubMedCrossRefGoogle Scholar
  27. 27.
    Mazarati AM, Baldwin RA, Sankar R, Wasterlain CG (1998) Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res 814(1–2):179–185PubMedCrossRefGoogle Scholar
  28. 28.
    Rathakrishnan R, Wilder-Smith EP (2009) New onset refractory status epilepticus (NORSE). J Neurol Sci 284(1–2):220PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Estevo Santamarina
    • 1
  • Manuel Toledo
    • 1
  • Maria Sueiras
    • 2
  • Miquel Raspall
    • 3
  • Nadim Ailouti
    • 2
  • Elena Lainez
    • 2
  • Isabel Porta
    • 4
  • R. de Gracia
    • 4
  • Manuel Quintana
    • 1
  • Javier Alvarez-Sabín
    • 1
  • Xavier Salas Puig
    • 1
  1. 1.Epilepsy Unit, Department of NeurologyHospital Universitari Vall d’HebronBarcelonaSpain
  2. 2.Department of Clinic NeurophysiologyHospital Universitari Vall d’HebronBarcelonaSpain
  3. 3.Department of NeuropediatryHospital Universitari Vall d’HebronBarcelonaSpain
  4. 4.Intensive Care UnitHospital Universitari Vall d’HebronBarcelonaSpain

Personalised recommendations