Lacosamide in the treatment of acute recurrent seizures and periodic epileptiform patterns in critically ill patients

Parkerson, Kimberly A.; Reinsberger, Claus; Chou, Sherry; Dworetzky, Barbara A.; Lee, Jong Woo

doi:10.1016/j.yebeh.2010.10.012

Cited by 30 publications

(35 citation statements)

References 23 publications

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“…Generally, PSIDDs are associated to toxic-metabolic encephalopathies, anoxic brain injury, CJD and subclinical or nonconvulsive status epilepticus (Fig 1) 5, [33][34][35][36][37][38][39] . Sometimes, it is difficult to distinguish the etiology of GPEDs, even with history and clinical findings suggesting or not an epileptic or toxic-metabolic etiology 34,[38][39][40] . Central nervous system infection, as neurosyphilis, has been described in association with GPEDs in patients with cognitive and behavioral disorders 41 .…”

Section: Generalized Periodic Epileptiform Dischargesgpedsmentioning

confidence: 99%

“…In a study with 25 patients presenting GPEDs, Husain et al 35 reported that 7 (28%) of them had toxic-metabolic encephalopathy, 10 (40%) had anoxia and toxic-metabolic encephalopathy, 8 (32%) had a primarily neurological process, and 8 (32%) were in status epilepticus. In practice, a clinical trial with AEDs is almost always warranted to differentiate nonconvulsive status epilepticus from severe encephalopathies although most patients will not respond clinically or electrographically 39,40 . Gloor et al 42 suggested that the periodicity of the discharges might be related to the recovery cycle of both cortical and subcortical structures, and that the subcortical discharges may be responsible for the surface discharges, but their repetition rate depends upon cortical recovery time.…”

Section: Generalized Periodic Epileptiform Dischargesgpedsmentioning

confidence: 99%

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Periodic EEG patterns: importance of their recognition and clinical significance

Andraus

Alves-Leon

2012

Arq. Neuro-Psiquiatr.

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Periodic electroencephalographic (EEG) patterns consist of discharges usually epileptiform in appearance, which occur at regular intervals, in critical patients. They are commonly classified as periodic lateralized epileptiform discharges (PLEDs), bilateral independent PLEDs or BIPLEDs, generalized epileptiform discharges (GPEDs) and triphasic waves. Stimulus-induced rhythmic, periodic or ictal discharges (SIRPIDs) are peculiar EEG patterns, which may be present as periodic discharges. The aim of this study is to make a review of the periodic EEG patterns, emphasizing the importance of their recognition and clinical significance. The clinical significance of the periodic EEG patterns is uncertain, it is related to a variety of etiologies, and many authors suggest that these patterns are unequivocally epileptogenic in some cases. Their recognition and classification are important to establish an accurate correlation between clinical, neurological, laboratorial and neuroimaging data with the EEG results.

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Section: Generalized Periodic Epileptiform Dischargesgpedsmentioning

confidence: 99%

Section: Generalized Periodic Epileptiform Dischargesgpedsmentioning

confidence: 99%

Periodic EEG patterns: importance of their recognition and clinical significance

Andraus

Alves-Leon

2012

Arq. Neuro-Psiquiatr.

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“…Although LCM is not FDA approved for SE, it has been evaluated in this setting in multiple case series, case reports, and retrospective reviews . The populations studied varied in the types of SE encountered: generalized, convulsive, absence, focal, complex partial, nonconvulsive, refractory, and super refractory (Table ).…”

Section: Discussionmentioning

confidence: 99%

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

et al. 2019

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Status epilepticus (SE) has a high mortality rate and is one of the most common neurologic emergencies. Fast progression of this neurologic emergency and lack of response to traditional antiepileptic drugs (AEDs) in most cases has challenged clinicians to use new agents. This article evaluates the efficacy and safety of AEDs released to the market after 2000 for SE, refractory status epilepticus (RSE), and super‐refractory status epilepticus (SRSE). The PubMed database was searched for clinical trials published between January 2000 and July 2018 using the search terms status epilepticus, refractory status epilepticus, super refractory status epilepticus, brivaracetam, clobazam, cannabidiol, eslicarbazepine, lacosamide, perampanel, rufinamide, stiripentol, and zonisamide. Trials that evaluated these agents in adults with SE, RSE, and SRSE were included. Brivaracetam use was identified in two retrospective reviews with success rates of 27% and 57%. One unsuccessful case report of cannabidiol use in SE was found. Four clobazam studies were identified in SE and RSE with success rates ranging from 25–100%. No evidence for the use of eslicarbazepine and zonisamide was found. Using the search terms for lacosamide identified 38 articles: 1 systematic review, 5 prospective studies, 15 retrospective reviews, and 17 case reports. Success rates and dosing varied, but studies that included focal or partial types of SE showed higher success rates. Five articles were identified regarding perampanel use in this setting. Three were retrospective reviews with success rates ranging from 17–60%, and two were case reports. Only one case report regarding the use of rufinamide was found; rufinamide titrated up to 4.4 mg/day allowed discontinuation of barbiturate and clobazam. One case report and two case series of stiripentol were found with reported efficacy between 60% and 100% in SRSE. Evidence is currently insufficient to support the use of these agents in this setting.

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“…However, we did not have the opportunity to assess favorable effects of lacosamide on photoparoxysmal responses, which have recently been reported. [18]…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Tolerability of Lacosamide in the Concomitant Treatment of 130 Patients Under 16 Years of Age with Refractory Epilepsy

et al. 2012

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BackgroundThe safety and effectiveness of lacosamide, an antiepileptic drug (AED) that selectively enhances the slow inactivation of voltage-gated sodium channels without affecting rapid inactivation, has been demonstrated in randomized, double-blind, placebo-controlled trials in adults with focal epileptic seizures. Although lacosamide is approved for use in patients over 16 years of age, limited clinical experience exists for younger patients.ObjectiveTo assess the efficacy and tolerability of lacosamide in children with refractory epilepsy.Design/MethodsThe trial was a prospective, open-label, observational, multicenter study. A total of 130 patients aged less than 16 years (range 6 months to 16 years) with refractory epilepsy who had initiated treatment with lacosamide were enrolled at 18 neuropediatric units in hospitals across Spain. Patients with a variety of etiologies were enrolled, including those with partial epilepsies and symptomatic, generalized epilepsy syndromes. Lacosamide (VIMPAT®; UCB Pharma SA, Brussels, Belgium) was primarily administered once every 12 hours as an oral solution or as an oral tablet, with an initial dose of 1–2 mg/kg/day in the majority of cases. The majority of patients were also receiving stable concomitant therapy with ≥1 other AED. Treatment response to lacosamide was determined by assessing the change in seizure frequency after 3 months of lacosamide therapy. Responders were defined as patients who achieved a seizure frequency reduction of >50%. Tolerability was assessed by the reporting of adverse effects, laboratory testing, and electroencephalography recordings.ResultsLacosamide was dosed at a mean of 6.80 ± 2.39 mg/kg/day. After 3 months of lacosamide therapy, 62.3% of patients achieved a >50% reduction in seizure frequency, with complete seizure suppression being reported in 13.8% of patients. Adverse effects occurred in 39 patients (30%), but no dose-response relationship was observed in terms of these events. In ten patients, instability, difficulty walking, an inability to relate to subjective elements, and blurred vision or dizziness were reported. A total of 13 patients discontinued treatment — in five of these patients, symptom intensity remained unchanged despite dose reduction, which led to treatment discontinuation. The symptoms were markedly different in each patient, preventing determination of a causal factor(s).ConclusionsThe results of this study provide preliminary evidence for the efficacy of lacosamide in children with refractory epilepsy. Further evaluation in a randomized, controlled trial is needed to validate the efficacy in this population and to fully investigate the adverse effects described here. We recommend an initial dose of 1–2 mg/kg/day, uptitrated to 6–9 mg/kg/day over 4–6 weeks.

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Lacosamide in the treatment of acute recurrent seizures and periodic epileptiform patterns in critically ill patients

Cited by 30 publications

References 23 publications

Periodic EEG patterns: importance of their recognition and clinical significance

Periodic EEG patterns: importance of their recognition and clinical significance

Use of Newer Anticonvulsants for the Treatment of Status Epilepticus

Efficacy and Tolerability of Lacosamide in the Concomitant Treatment of 130 Patients Under 16 Years of Age with Refractory Epilepsy

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