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The Safety and Effectiveness of Intravenous Lacosamide for Refractory Status Epilepticus in the Critically Ill

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Abstract

Background

Status epilepticus (SE) often does not respond to initial treatment. A second-line agent with a less established safety and efficacy profile is then required. This study examined the safety of intravenous (IV) lacosamide (LCM) in a critically ill population and obtained an estimate of effectiveness in patients with refractory SE on continuous video EEG monitoring (cEEG).

Methods

Retrospective review of critically ill patients in SE on cEEG treated with IV LCM from June 2009 to April 2011.

Results

Eighty-four patients in SE (43 F/41 M), mean age 59.6 years, were identified; and 59.5 % had nonconvulsive SE. The most common etiologies were ischemic and hemorrhagic strokes. There were no significant changes in serial blood pressure monitoring, PR prolongation, aspartate aminotransferase (AST), or creatinine pre- and post-LCM. There was a significant increase in alanine aminotransferase (ALT) from days 1–7 (p = 0.031). Fifty-one patients were LCM-naïve. In these patients, cessation of SE on cEEG after LCM occurred in 15.7, 25.5, 58.8, and 82.4 % by 4, 12, 24, and 48 h, respectively.

Conclusion

IV LCM appears safe short term in critically ill patients with SE. The retrospective estimate of effectiveness for LCM appears promising for management in SE. Prospective, randomized controlled studies are needed to better determine the role of LCM in treating SE.

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Authors’ Contribution

Christopher R. Newey, Minh Le, Christine Ahrens, Pradeep Sahota and Stephen Hantus contributed equally to the writing of the case and formatting the images.

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Authors and Affiliations

  1. Department of Neurology, University of Missouri, 5 Hospital Drive, CE 540, Columbia, MO, 65211, USA

    C. R. Newey & P. Sahota

  2. Pediatric Neurology, Orlando Health System, 7485 Sand Lake Commons Blvd, Orlando, FL, 32819, USA

    N. M. Le

  3. Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    C. Ahrens

  4. Cerebrovascular Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    S. Hantus

  5. Epilepsy Center, Neurologic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195-5245, USA

    S. Hantus

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  1. C. R. Newey
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Correspondence to C. R. Newey.

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Conflict of interest

Christopher R. Newey, Minh Le, Christine Ahrens, and Pradeep Sahota have no financial disclosures to report. Stephen Hantus has served as a consultant and on advisory boards for UCB pharma.

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Newey, C.R., Le, N.M., Ahrens, C. et al. The Safety and Effectiveness of Intravenous Lacosamide for Refractory Status Epilepticus in the Critically Ill. Neurocrit Care 26, 273–279 (2017). https://doi.org/10.1007/s12028-016-0322-2

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  • DOI: https://doi.org/10.1007/s12028-016-0322-2

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