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Neurocritical Care

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01-04-2012 | Original Article

Safety and Efficacy of Lacosamide in the Intensive Care Unit

Authors: Sunil Cherry, Lilith Judd, Juan Carlos Muniz, Hoda Elzawahry, Suzette LaRoche

Published in: Neurocritical Care | Issue 2/2012

Abstract

Background

Seizures are common in critically ill patients and can impact morbidity and mortality. Traditional anti-epileptic drugs (AEDs) in this setting are not always effective and are associated with adverse events and drug interactions. Lacosamide (LCM) is a new AED which is available in parental form although few studies have evaluated the safety and efficacy of LCM in critically ill patients.

Methods

Critically ill patients at Emory University Hospital who received LCM from April 1, 2009 to February 1, 2010 were retrospectively reviewed. Primary outcome measure was incidence and time to seizure cessation. Adverse effects were also recorded.

Results

LCM was administered in 24 patients including 13 episodes of refractory status epilepticus (RSE) occurring in 10 patients and for treatment of isolated seizures or following resolution of RSE in an additional 14 patients. Seizure cessation was achieved in 5/13 (38%) episodes of RSE (mean 11.2 h) while there was at least a 50% decrease in seizure frequency in 7/13 (54%). 11/14 patients (76%) who received LCM for treatment of isolated seizures or prevention of seizure recurrence remained seizure free. Three patients experienced a decline in systolic blood pressure (>20 mmHg) while one patient experienced unexplained fever and one patient had elevation of liver function tests.

Conclusions

This preliminary data suggests that LCM may be a safe and effective alternative for treatment of seizures in critically ill patients. Further prospective, randomized controlled trials are needed to confirm these findings and further explore the incidence of adverse effects.

Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004;62(10):1743–8.PubMed

Pandian JD, Cascino GD, So EL, Manno E, Fulgham JR. Digital video-electroencephalographic monitoring in the neurological–neurosurgical intensive care unit: clinical features and outcome. Arch Neurol. 2004;61(7):1090–4.PubMedCrossRef

Jordan KG. Neurophysiologic monitoring in the neuroscience intensive care unit. Neurol Clin. 1995;13(3):579–626.PubMed

Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage. Neurology. 2007;69(13):1356–65.PubMedCrossRef

Vespa PM, Miller C, McArthur D, et al. Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med. 2007; 35(12):2830–6.

Vespa PM, O’Phelan K, Shah M, et al. Acute seizures after intracerebral hemorrhage: a factor in progressive midline shift and outcome. Neurology. 2003;60(9):1441–6.PubMed

Vespa P. Continuous EEG monitoring for the detection of seizures in traumatic brain injury, infarction, and intracerebral hemorrhage: “to detect and to protect”. J Clin Neurophysiol. 2005;22(2):99–106.PubMedCrossRef

Privitera M, Hoffman M, Moore JL, Jester D. EEG detection of nontonic-clonic status epilepticus in patients with altered consciousness. Epilepsy Res. 1994;18(2):155–66.PubMedCrossRef

De Lorenzo RJ, Waterhouse EJ, Towne AR, et al. Persistent nonconvulsive status epilepticus after the control of convulsive status epilepticus. Epilepsia. 1998;39(8):833–40.CrossRef

10.

Young B, Jordan K, Doig G. An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology. 1996;47:83–9.PubMed

11.

Vespa P, McArthur DL, Glenn T, et al. Nonconvulsive seizures after traumatic brain injury are associated with hippocampal atrophy. Neurology. 2010; 75(9):792–8.

12.

Treiman DM, Meyers PD, Walton NY, et al. A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998;339(12):792–8.PubMedCrossRef

13.

Ben-Menachem E, Biton V, Jatuzis D, Abou-Khalil B, Doty P, Rudd GD. Efficacy and safety of oral lacosamide as adjunctive therapy in adults with partial-onset seizures. Epilepsia. 2007;48(7):1308–17.PubMedCrossRef

14.

Biton V, Rosenfeld WE, Whitesides J, Fountain NB, Vaiciene N, Rudd GD. Intravenous lacosamide as replacement for oral lacosamide in patients with partial-onset seizures. Epilepsia. 2008;49(3):418–24.PubMedCrossRef

15.

Beyreuther BK, Freitag J, Heers C, Krebsfanger N, Scharfenecker U, Stohr T. Lacosamide: a review of preclinical properties. CNS Drug Rev. 2007;13(1):21–42.PubMedCrossRef

16.

Koubeissi MZ, Mayor CL, Estephan B, Rashid S, Azar NJ. Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus. Acta Neurol Scand. 2010;123(2):142–6.PubMedCrossRef

17.

Tilz C, Resch R, Hofer T, Eggers C. Successful treatment for refractory convulsive status epilepticus by non-parenteral lacosamide. Epilepsia. 2010;51(2):316–7.PubMedCrossRef

18.

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.PubMedCrossRef

19.

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.PubMedCrossRef

20.

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.PubMedCrossRef

21.

Goodwin H, Hinson HE, Shermock KM, Karanjia N, Lewin JJ, 3rd. The Use of Lacosamide in Refractory Status Epilepticus. Neurocrit Care. 2011; 14(3):348–53.

22.

Kellinghaus C, Berning S, Immisch I, et al. Intravenous lacosamide for treatment of status epilepticus. Acta Neurol Scand. 2010;123(2):137–41.PubMedCrossRef

Title: Safety and Efficacy of Lacosamide in the Intensive Care Unit
Authors: Sunil Cherry
Lilith Judd
Juan Carlos Muniz
Hoda Elzawahry
Suzette LaRoche
Publication date: 01-04-2012
Publisher: Humana Press Inc
Published in: Neurocritical Care / Issue 2/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-011-9662-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Safety and Efficacy of Lacosamide in the Intensive Care Unit

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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