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Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus

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Abstract

Background and Objectives

Status epilepticus (SE) is an important emergency situation associated with high morbidity and mortality. The goal of pharmacological therapy—rapid seizure termination—is only achieved in just over half of patients with first-line anti-epileptic drug (AED) therapy and many patients require second and higher lines of AEDs to achieve seizure termination; therefore, there is a clear need for more effective treatment options. Lacosamide is a relatively new AED and the intravenous formulation has shown promise for treatment of SE. The aim of the current study was to compare electroencephalographic (EEG) response and seizure termination with intravenous lacosamide (±other AEDs) in patients with convulsive versus non-convulsive SE, in a Spanish intensive care setting.

Methods

In this prospective, observational study, patients with convulsive or non-convulsive SE who received intravenous lacosamide 400 mg/day for 8 days were compared in terms of EEG response and seizure termination. Adverse events were not specifically assessed.

Results

Fifty-three patients (69.8 % male; mean age 55.2 years) were treated with lacosamide (mean dose 390.6 mg) as first- (20.8 %), second- (34 %), third (22.6 %) or fourth-line (22.6 %) treatment for convulsive (n = 23, 43.4 %) or non-convulsive (n = 30, 56.6 %) SE. The majority of patients (73.6 %) had a comorbid condition, predominantly hypertension (35.8 %), and most (79.2 %) received at least one concomitant AED, including midazolam (54.7 %), valproic acid (52.8 %), and levetiracetam (30.2 %). Patient characteristics and treatment received did not differ significantly between the convulsive and non-convulsive SE groups. EEG recordings following lacosamide treatment demonstrated the elimination of paroxysmal activity (disappearance and/or attenuation of epileptiform activity in >60 % of recording time) in 56.6 % of patients; 69.6 % of convulsive and 46.7 % of non-convulsive SE groups. Among all patients, 90.6 % showed some EEG improvement (disappearance of epileptiform activity in <30 % total recording time or disappearance and/or attenuation of epileptiform activity in 30–60 % total recording time); and there was no significant between-group difference for achievement of seizure termination (90.0 vs. 91.3 % for non-convulsive vs. convulsive SE).

Conclusions

Intravenous lacosamide (±other AEDs) was similarly effective in patients with convulsive or non-convulsive SE. Further investigation into the use of lacosamide in the treatment of SE is warranted.

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Acknowledgments

The authors would like to thank the Clinical Pharmacology Service, Hospital Universitario de Santiago de Compostela for providing the necessary data for the study.

Medical writing assistance with the preparation of this manuscript was provided by Claire Pouwels, Tracy Harrison and Mary Hines of inScience Communications, Springer Healthcare with funding provided by Hospital Universitario de Santiago de Compostela.

Author contributions

All authors participated in the conception, design, and implementation of the study. All authors were involved in the analysis and interpretation of data and the decision to submit for publication.

Conflict of interest

Eros Yamel Moreno Morales, Manuel Fernandez Peleteiro, Ernesto Carlo Bondy Peña, Jose Maria Domínguez Lorenzo, Elva Pardellas Santiago and Anxo Fernández have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Clinical Neurophysiology, University Hospital of Santiago de Compostela, Outpatient Building (Floor 1), Office 325, Santiago de Compostela, Spain

    Eros Yamel Moreno Morales, Manuel Fernandez Peleteiro, Ernesto Carlo Bondy Peña, Jose Maria Domínguez Lorenzo & Elva Pardellas Santiago

  2. Clinical Pharmacology Service, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    Anxo Fernández

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  1. Eros Yamel Moreno Morales
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  2. Manuel Fernandez Peleteiro
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  4. Jose Maria Domínguez Lorenzo
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Correspondence to Manuel Fernandez Peleteiro.

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Moreno Morales, E.Y., Fernandez Peleteiro, M., Bondy Peña, E.C. et al. Observational Study of Intravenous Lacosamide in Patients with Convulsive Versus Non-Convulsive Status Epilepticus. Clin Drug Investig 35, 463–469 (2015). https://doi.org/10.1007/s40261-015-0295-5

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  • DOI: https://doi.org/10.1007/s40261-015-0295-5

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