In adults with benzodiazepine-resistant status epilepticus (SE), the response rate to intravenous lacosamide was highest with the use of weight-adjusted doses >5.3 mg/kg, according to results from a multicenter, retrospective study published in Epilepsy & Behavior.
The investigators sought to evaluate the association between loading weight-adjusted dose and efficacy of intravenous lacosamide in patients with SE. A group of patients with SE who were treated with lacosamide were examined retrospectively. Demographic data, type of SE experience, etiology of SE, response rate, last antiepileptic drug used, total loading dose of lacosamide used, weight-adjusted dose of lacosamide used, and treatment line in which lacosamide was used were all obtained for each study participant.
A total of 165 patients with SE were investigated. Overall, 52.7% (87 of 165) of the patients had nonconvulsive SE. The mean patient age was 64.2±17.2 years; 60.6% of the participants were men. With respect to etiology, SE was considered to be acute symptomatic in 51.5% (85 of 165) of patients, remote symptomatic in 30.9% (51 of 165), progressive symptomatic in 6.1% (10 of 165), and cryptogenic in 11.5% (19 of 165) of the participants.
Lacosamide was used as the third drug in 46.1% of patients and as a second treatment in 28%. Clonazepam had been used as first-line treatment in 115 patients, and no benzodiazepines had been used in the remaining 60 individuals.
The mean loading dose of lacosamide was 400 mg (100-600 mg), and the weight-adjusted dose was 5 mg/kg (3-6 mg/kg). Patient response rate to lacosamide was 63.3%, with 55.1% of the participants responding within the first 12 hours.
The efficacy was reported to be significantly higher in those patients with lacosamide loading doses >5.3 mg/kg who had taken benzodiazepines (P =.006). This association was maintained independent of the use of concomitant antiepileptic drugs. If benzodiazepines had not been used, however, this relationship was not observed.
The investigators concluded that prospective studies are warranted to validate the upper limit of the weight-adjusted dose of lacosamide that should be used in adult patients with SE.
Santamarina E, González-Cuevas M, Toledo M, et al. Intravenous lacosamide (LCM) in status epilepticus (SE): weight-adjusted dose and efficacy. Epilepsy Behav. 2018;84:93-98.