Intravenous lacosamide in seizure emergencies: Observations from a hospitalized in-patient adult population

Abstract Purpose to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients. Methods we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200–400mg and the maintenance dose was 200–400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion. Results an acute anti-seizure effect after IV LCM was especially evident when it was first used – (SC) or second line (established SE) treatment. In particular, 87% of SC patients (13/15) and 80% of established SE (8/10) demonstrated response to LCM treatment, while no patients with super-refractory SE (0/8) responded to IV LCM according to our criteria. The loading of IV LCM was well tolerated, with mild adverse effects (2/38 temporary dizziness). In most patients, during and after administration of the loading dose of IV LCM a temporary (30min–1h) sedation was observed. No ECG and laboratory values-changes were documented in any of the patients. Conclusions LCM is an effective and well-tolerated treatment when used to treat SC in hospitalized adult patients. As add-on therapy, it may be useful to stop seizure activity in patients with focal SE not responding to first/second-line intravenous AEDs.