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Volume 7 Issue 3 (March, 2019)

Original Articles

Safety and Efficacy of Intravenous Lacosamide in Refractory Status Epilepticus
Amit Sharma, Parampreet Singh, Manoj K Goyal, Vivek Lal

Introduction: SE has been defined as “a condition characterized by an epileptic seizure which is so frequently repeated or so prolonged as to create a fixed and lasting epileptic condition”. While there is a uniform agreement that SE should be treated on an emergent basis, treatment protocols of SE continue to be controversial. Refractory status epilepticus establishes in 23-43% section of the patients with SE. Lacosamide (LCM) is one of the newer antiepileptic drugs  and since its introduction, use of this drug is steadily increasing. Aim: To evaluate the safety profile and efficacy of LCM in RSE, as compared to other conventional 2nd line agents. Material and methods: The present study was carried out on 52 patients of RSE, who were admitted in the Emergency Medical Department or Neurology ward, of our tertiary care hospital (Postgraduate Institute of Medical Education and Research, Chandigarh). The patients were randomly divided into two equal groups – Cases and Controls. Patients in Cases group (n=26) received IV LCM in a dosage of a200mg IV bolus, while patients in Controls group (n=26) received a second conventional AED (either phenytoin or levetiracetam depending upon the first used agent .Severity of status epilepticus (SE) was graded by the SE Severity Scale (STESS). All the patients underwent detailed investigations for determination of underlying etiology, as per the proforma attached. Results: On Comparisons of both demography and clinical characteristics including SE severity gradation by STESS, no significant differences in SE severity and etiology or critical medical conditions between both groups. However, requirement of add on AEDs was comparable in both the groups. It was observed that Phenytoin plus levetiracetam (Control group) achieved control of RSE in 6 (23.08%) patients compared to 10 (38.46%) patients who were infused phenytoin or levetiracetam plus lacosamide (Case group). None of patients in lacosamide group had adverse effects, while one female patient in phenytoin group developed hypotension, from which she recovered. Further, 25 (48.08%) expired during the course of the study, while 27 (51.92%) recovered. On comparing the two groups with respect to the outcome of treatment, the study observed no significant difference between the two groups. Conclusion: LCM appears to be a safe and effective alternative for treatment of seizures in critically ill patients. The low rate of response may be due to LCM being used as a 3rd line drug and dose used of LCM was 200 mg only. However, number of patients was relatively small and further large RCTs are required to confirm above findings.
Key words: Lacosamide, Refractory status epilepticus, safety, efficacy

Received: 18 January, 2019                                    Revised: 18 February, 2019                           Accepted: 19 February, 2019

Corresponding author: Dr. Amit Sharma, Senior Resident, Department of Neurology, Post Graduate Institute of Medical Education & Research, Chandigarh, India

This article may be cited as: Sharma A, Singh P, Goyal MK, Lal V. Safety and Efficacy of Intravenous Lacosamide in Refractory Status Epilepticus.  J Adv Med Dent Scie Res 2019;7(3): 143-147.

 
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