Nonconvulsive status epilepticus (NCSE) and epilepsia partialis continua (EPC) are common epileptic conditions for which straightforward recommendations based on controlled randomized trials for treatment in therapy refractory courses are lacking. In a large retrospective study on drug efficacy in status epilepticus (SE) we identified the patients treated in our department by searching for the term "status epilepticus" in the electronic archive of medical reports of our clinic. Here we present the subset of data concerning the patients treated with lacosamide (LCM). Ten episodes of SE in nine patients could be analyzed. To control for age dependency of results at discharge we calculated a Spearman correlation coefficient with age as independent variable and return to baseline Modified Rankin Score (mRS) at discharge=1, worsening of condition at discharge (i.e. new neurological deficit or worsening of mRS)=2 and death in hospital=3 as dependent variables. LCM was given in dosages of 50-100mg. It was not earlier administered than as fourth drug. Nevertheless it seemed to be effective for termination of status epilepticus in 20% of the episodes. But the outcome at discharge seemed considerably to depend on age of patients (r=0.94, explaining 89% of variance).
Non-convulsive status epilepticus and epilepsia partialis continua are common epileptic conditions for which straightforward recommendations based on controlled randomised trials for treatment of therapy refractory courses are lacking. Therefore in these conditions sometimes antiepileptic drugs that are not approved by governmental authorities for the treatment of status epilepticus (SE) are used. Here we review all case reports and case series concerning the treatment of SE with levetiracetam (LEV), that had been listed in pub-med up to December 12th 2011. Additionally we analysed abstracts and papers in peer reviewed journals, that were listed in the references of the primarily reviewed papers. Furthermore we looked for LEV treatments in papers on the use of lacosamide (LCM) in SE. LEV was given in dosages ranging from 500 mg to 9000 mg per day. Side effects were especially sedation and irritability. Estimated on the basis of the case series the overall success-rate of LEV in terminating status epilepticus may be set in a range between 53.7% and 58.1%. Therefore LEV may be a useful alternative for the treatment of SE when the approved drugs are contraindicated or when these drugs have been taken without success.
Zusammenfassung Ausgangspunkt: F?r den Nonkonvulsiven Status epilepticus (NKSE) und die Epilepsia partialis continua (EPC) sind die therapeutischen Empfehlungen in den meisten Leitlinien nicht so eindeutig wie f?r den Status generalisierter tonisch-klonischer Anf?lle (GTKSE). NKSE und EPC sind aber nicht selten therapierefrakt?r. Daher kommen hier gelegentlich auch Substanzen zum Einsatz, die ?ber keine Zulassung f?r die Behandlung eines Status epilepticus (SE) verf?gen. Methodik: Im Rahmen dieser ?bersichtsarbeit wurden die bis zum 10.12.2011 in PubMed gelisteten Einzelfallberichte und Fallserien zur Lacosamid (LCM)-Anwendung bei unterschiedlichen Formen des SE erg?nzt um einen zu diesem Zeitpunkt eingereichten Einzelfallbericht analysiert. Ergebnisse und Schlussfolgerung: LCM wurde in Dosen von 50?mg bis 800?mg eingesetzt. An Komplikationen wurden atrioventrikul?re Blockbildungen h?heren Grades, allergische Hautreaktionen und Angioneurotische ?deme berichtet. Mit einer auf Basis der Fallserien gesch?tzten Gesamterfolgsrate von 53% bis 63% scheint LCM eine m?gliche Behandlungsoption eines NKSE oder einer EPC bei bestehenden Kontraindikationen f?r etablierte Therapieverfahren oder nach deren erfolglosem Einsatz zu sein.
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