F24. Evaluation of cardiovascular parameters during intravenous loading dose of lacosamide

Introduction Several recent reports have described the efficacy of intravenous (IV) lacosamide (LCS) in the management of acute seizures and status epilepticus (SE). Based on data from 3 randomized control trials LCS appeared to be well tolerated. However, previous studies of patients on maintenance LCS therapy have reported Electrocardiographic (ECG) changes including conduction disturbances and sinus node dysfunction. A study of IV LCS boluses of 200, 300, and 400 mg administered over 15 min to outpatient subjects with epilepsy showed no changes in ECG during the infusions. We performed a retrospective review of adult patients who received IV LCS of 400–1400 mg and evaluated for changes in cardiovascular parameters during and immediately after the loading dose. Methods With IRB approval, patients were identified that received IV LCS in the ICU for acute treatment of seizures during the years 2013–2016. Data elements collected were age, gender, weight, duration of infusion, change or termination of infusion because of immediate side effects, heart rate changes, blood pressure changes, oxygen saturation changes, and use of vasopressor agents one hour before, during and up to one hour after the infusion completed. All loading doses were administered over 30–60 min. No concurrent other anti-epileptic medication was given during loading dose of LCS. Results Three hundred and fifty-four adult patients were identified that were treated with LCS for seizures and SE in the ICU. 318/354 patients had IV loading dose of 400–1400 mg. Demographics were male/female (130/188), average weight 83.7 kg (range 40.8–219.5), and average age was 60 yrs (18–97). Ranges of the bolus doses included 400–600 mg (210 pts), 601–800 mg (78 pts) and 801–1400 mg (30 pts). No patients required a change or discontinuation of the infusion due to acute side effects. No patients required vasopressors from blood pressure changes during the bolus. The systolic blood pressure (mm Hg) 1 h prior, during, and 1 h post bolus were 137.56 ± 25.3, 133.4 ± 24.87, and 131.6 ± 25.89 (measured with 1 standard deviation). Similarly, the diastolic measurements were 72.3.9 ± 12.87, 72.7 ± 13.78, and 69.94 ± 13.46. Similarly, the heart rate measurements were 86.98 ± 19.73, 85.92 ± 18.85, and 85.22 ± 18.25. Conclusion Patients with refractory SE who require anesthetic agents or repeated doses of benzodiazepines are most vulnerable to severe hypotension which complicates the management and increases risk for organ hypo-perfusion and mortality. The choice of IV antiepileptic medications is limited since IV fosphenytoin has been associated with substantial hypotension. In our study IV bolus doses of LCS appears to have no deleterious cardiovascular effects thus favoring its use in the management of acute seizures and SE. Furthermore, we did not identify any malignant changes in heart rate related to the bolus dose ranging from 400 to 1400 mg.