Abstracts

Rationale: Status epilepticus (SE) and seizure clusters represent neurological emergencies. The mortality rate for adults ranges from 11% to 34%, depending on cause and co-morbidity (Delorenzo et al., 1996). As SE become more refractory to treatment over time, rapid, appropriate treatment is of particular importance. This study aimed to investigate the effectiveness and tolerability of IV lacosamide (LCM) in treatment of seizure clusters and SE after failure of first line treatment benzodiazepines. Methods: All patients treated with IV LCM between December 2009 and January 2010 were retrospectively enrolled in our study. We analyzed indications for treatment, dose, responsiveness and adverse events. Indications for IV LCM were (1) previously unsuccessfully treated SE or (2) seizure clusters triggered by antiepileptic drug (AED) reduction during video-EEG monitoring due to rapid down titration. Results: Nineteen consecutive patients (12f/7m) aged 20-91 years (median 53 years) were included in the study. Six patients had convulsive SE, three patients nonconvulsive SE and ten patients had seizure clustering. The atiology of epilepsy was in 6/19 traumatic laesions, in 5/19 cortical dysplasia, in 4/19 vascular laesions, in 2/19 cryptogenic, in 1/19 vitamin B-hypovitaminosis and in 1/19 an aluminium intoxication. The initial dosis was mean 257.9 mg (SD 90.2), median 200 mg (range 200-400). The rate of infusion in patients with SE ranged between 40 - 57mg/min, in patients with seizure clusters 20 - 57mg/min. LCM IV was used as third drug. Nonconvulsive SE was terminated with LCM IV in 3/3 patients, convulsive SE in 1/6 patients and in 8/10 patients with seizure clusters LCM IV was effective. Except pruritus in one patient no side-effects were observed, especially no cardiovascular effects were observed. Conclusions: These data support consideration of LCM IV use as a safe alternative to standard AED therapies for acute treatment of seizure emergency situations. Further studies on optimal dose, rate of infusion efficacy and safety are needed. (1) Delorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, Garnett L, Fortner CA, Ko D. (1996) A prospective, population- based epidemiologic study of status epilepti- cus in Richmond, Virginia. Neurology 46: 1029-35.