Abstracts

Rationale: Pregabalin (PGB) has been approved for adjunctive therapy for treatment of patients with refractory seizures. To date there are no studies of use of PGB for treatment of status epilepticus. The purpose of this study was to determine the efficacy of PGB in treatment of frequent nonconvulsive seizures (NCS) and nonconvulsive status epilepticus (NCSE) in critically ill patients. Methods: Charts of patients with seizures determined by long-term electroencephalographic (EEG) monitoring were reviewed. Patients who received PGB for acute therapy were reviewed in detail. The patients were considered to be responders if their seizures were terminated with in 24 hrs of initiation of PGB without the addition of an additional antiepileptic agent. Characteristics of subjects whose seizures or NCSE was terminated with PGB were compared to those for whom this drug was not successful. In particular, the etiology, prior use of AED, as well as final outcome was noted. The dosing pattern of PGB, final dosage and adverse effects were recorded as well. Results: A total of 52 patients received PGB for treatment of seizures or for chronic pain. Of these, 22 patients received PGB for treatment of NCS or NCSE; 11 (50%) of them were responders. PGB was administered via the nasogastric tube or orally and was administered as the 3rd to 5th agent. All of the patients had received levetiracetam prior to addition of PGB. The average initial dose and total daily dose of PGB was similar in the responders and non responders (395 mg vs. 391 mg). A total of 18% of the responders were noted to have NCSE, while 55% of non responders had NCSE. Duration of seizures was 16 hours for responders vs. 35 hrs for non responders. Etiology was related to hypoxic brain injury in 4 of 11 (36%) of the non responders as compared to none (0) of the responders. The responders were noted to have better clinical outcome (64% vs. 9% discharged home). Most of the patients tolerated the medication without any significant short term adverse effects, except two patients who were noted to have dizziness and sedation. Conclusions: Pregabalin appears to be efficacious as add-on for treatment of nonconvulsive seizures and status epilepticus in critically ill patients.