Skip to main content
SpringerLink
Log in

Intravenous Lacosamide in Refractory Seizure Clusters and Status Epilepticus: Comparison of 200 and 400 mg Loading Doses

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

The treatment of refractory status epilepticus (RSE) remains largely empirical. Lacosamide (LCM) is a new anticonvulsant available in intravenous (IV) form, but its optimal dosing regimen for the treatment of RSE is unknown. We compared safety and efficacy of two loading doses: 200 and 400 mg.

Methods

Prospective observational study of all patients who received IV LCM for RSE or seizure clusters between October 2010 and December 2012. A first group received an IV load of 200 mg of LCM. After the initial part of the study, and due to poor results with this dosage, a second group received a loading dose of 400 mg. Outcome measures included response rate, time to response, and adverse events.

Results

There was a trend in favor of a higher response rate to LCM in the 400 mg group [7/14 (50 %) vs. 2/11 (18 %), respectively; p = 0.2]. Early responses (occurring within 3 h of initiation of LCM) were significantly more frequent in the 400 mg group [4/14 (28 %) vs. 0/11 (0 %); p = 0.026]. Overall, 9/25 patients (36 %) responded to LCM and seizures were terminated in eight more patients (32 %), by adding other anticonvulsants. The following adverse events were attributed to LCM: myoclonus and confusion, increase in seizure frequency, vertigo, ataxia, and an asymptomatic increase in liver enzymes level. All occurred in the 200 mg group. No skin rash, renal, cardiac, or hemodynamic side effects were observed in any group.

Conclusions

In this small prospective observational study, an initial dose of 400 mg of IV LCM was associated with a higher proportion of early termination of RSE and with a trend toward a higher response rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Meierkord H, Boon P, Engelsen B, et al. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol. 2010;17:348–55.

    Article  CAS  PubMed  Google Scholar 

  2. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3–23.

    Article  PubMed  Google Scholar 

  3. Hocker SE, Britton JW, Mandrekar JN, Wijdicks EFM, Rabinstein AA. Predictors of outcome in refractory status epilepticus. Arch Neurol. 2012;8:1–6.

    Google Scholar 

  4. Kowalski RG, Ziai WC, Rees RN, et al. Third-line antiepileptic therapy and outcome in status epilepticus: the impact of vasopressor use and prolonged mechanical ventilation. Crit Care Med. 2012;40(9):2677–84.

    Article  CAS  PubMed  Google Scholar 

  5. Alvarez V, Januel JM, Burnand B, Rossetti AO. Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam. Epilepsia. 2011;52(7):1292–6.

    Article  CAS  PubMed  Google Scholar 

  6. Albers JM, Moddel G, Dittrich R, et al. Intravenous lacosamide—an effective add-on treatment of refractory status epilepticus. Seizure. 2011;20(5):428–30.

    Article  PubMed  Google Scholar 

  7. Rantsch K, Walter U, Wittstock M, Benecke R, Rosche J. Efficacy of intravenous lacosamide in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Seizure. 2011;20(7):529–32.

    Article  PubMed  Google Scholar 

  8. Parkerson KA, Reinsberger C, Chou SH, Dworetzky BA, Lee JW. Lacosamide in the treatment of acute recurrent seizures and periodic epileptiform patterns in critically ill patients. Epilepsy Behav. 2011;20(1):48–51.

    Article  PubMed  Google Scholar 

  9. Koubeissi MZ, Mayor CL, Estephan B, Rashid S, Azar NJ. Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus. Acta Neurol Scand. 2011;123(2):142–6.

    Article  CAS  PubMed  Google Scholar 

  10. Kellinghaus C, Berning S, Immisch I, et al. Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand. 2011;123(2):137–41.

    Article  CAS  PubMed  Google Scholar 

  11. Hofler J, Unterberger I, Dobesberger J, Kuchukhidze G, Walser G, Trinka E. Intravenous lacosamide in status epilepticus and seizure clusters. Epilepsia. 2011;52(10):e148–52.

    Article  PubMed  Google Scholar 

  12. Goodwin H, Hinson HE, Shermock KM, Karanjia N, Lewin JJ III. The use of lacosamide in refractory status epilepticus. Neurocrit Care. 2011;14(3):348–53.

    Article  CAS  PubMed  Google Scholar 

  13. Jain V, Harvey AS. Treatment of refractory tonic status epilepticus with intravenous lacosamide. Epilepsia. 2012;53(4):761–2.

    Article  PubMed  Google Scholar 

  14. Mnatsakanyan L, Chung JM, Tsimerinov EI, Eliashiv DS. Intravenous lacosamide in refractory nonconvulsive status epilepticus. Seizure. 2012;21(3):198–201.

    Article  CAS  PubMed  Google Scholar 

  15. Cherry S, Judd L, Muniz JC, Elzawahry H, LaRoche S. Safety and efficacy of lacosamide in the intensive care unit. Neurocrit Care. 2012;16(2):294–8.

    Article  CAS  PubMed  Google Scholar 

  16. Höfler J, Trinka E. Lacosamide as a new treatment option in status epilepticus. Epilepsia. 2013;54(3):393–404.

    Article  PubMed  Google Scholar 

  17. Young GB, Jordan KG, Doig GS. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47(1):83–9.

    Article  CAS  PubMed  Google Scholar 

  18. Belcastro V, Arnaboldi M, Taborelli A, Prontera P. Induction of epileptic negative myoclonus by addition of lacosamide to carbamazepine. YEBEH. 2011;20(3):2.

    Google Scholar 

Download references

Disclosures

This study was not initiated, and not sponsored by UCB. Marcel Levy-Nogueira, Noémie Ligot, Gilles Naeije have no conflict of interest. Nicolas Mavroudakis received travel grant from Pfizer. Chantal Depondt received research grant and travel grant from UCB. Those grants were unrelated to this study. Benjamin Legros received research grant from UCB, speaker honorarium from UCB, Pfizer, GSK, and Sanofi, consulting honorarium from UCB, GSK, Pfizer, travel grants from UCB, Pfizer, GSK, Janssens Cilag, Novartis, Sanofi and Cyberonics. The research grant was unrelated to this study. Two travel grants were used to present partial data of this study. Nicolas Gaspard is the recipient of a Postdoctoral Research Fellowship from the Epilepsy Foundation of America, was the recipient of a Postdoctoral Research Fellowship from the Belgian American Education Foundation, and received research grant from the Commission for Educational Exchange between the USA and Belgium and the Belgian Neurological Society.

Author information

Authors and Affiliations

  1. Department of Neurology, Reference Center for the Treatment of Refractory Epilepsy, ULB-Hôpital Erasme, 808, Route de Lennik, 1070, Brussels, Belgium

    Benjamin Legros, Chantal Depondt, Marcel Levy-Nogueira, Noémie Ligot, Nicolas Mavroudakis, Gilles Naeije & Nicolas Gaspard

  2. Computational Neurophysiology Laboratory and Comprehensive Epilepsy Center, Yale University, New Haven, CT, USA

    Nicolas Gaspard

Authors
  1. Benjamin Legros
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chantal Depondt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marcel Levy-Nogueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Noémie Ligot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicolas Mavroudakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gilles Naeije
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicolas Gaspard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Legros.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Legros, B., Depondt, C., Levy-Nogueira, M. et al. Intravenous Lacosamide in Refractory Seizure Clusters and Status Epilepticus: Comparison of 200 and 400 mg Loading Doses. Neurocrit Care 20, 484–488 (2014). https://doi.org/10.1007/s12028-013-9882-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-013-9882-6

Keywords

Search

Navigation