Lacosamide/lamotrigine overdose

Abstract

A 26-year-old man developed status epilepticus and coma following self poisoning and overdose with lacosamide and lamotrigine in a suicide attempt.The man, who had a history of atypical left temporal lobe epilepsy ingested lacosamide 6g (30 tablets of 200mg) and lamotrigine 8g(40 tablets of 200 mg) during a suicide attempt. He presented to the emergency unit of the hospital. On presentation, he was agitated and developed tonic-clonic seizure. He also had multiple wounds on his head caused by banging against the radiator.The man was treated with diazepam. However, his seizure reoccurred. He was then retreated with diazepam. Subsequently, his vital sign stabilised. He was then transferred to the emergency department, where he presented with a deep coma (Glasgow Coma Score 3). Immediately after admission to the emergency department, seizure again recurred. He was then treated with clonazepam to control status epilepticus. Tracheal intubation was performed after midazolam, fentanyl and celocurine administration. He was then admitted to the intensive care unit (ICU). Physical examination showed blood pressure 130/90 mmHg and pulse 75/minute. A laboratory investigation revealed elevated levels of creatine phosphokinase (CPK). Post admission to the ICU, he was treated with continuous infusion of propofol and clonazepam. Forty-six hours post admission, propofol was discontinued. He recovered his consciousness. however, he was found to be agitated. Propofol treatment was started again and totally stopped after 69 hours. He became awake and extubated. Monitoring of lacosamide and lamotrigine serum concentrations were carried out during hospitalisation or about 70 hours.Author comment: "We described the clinical course of a patient who ingested 6 g of lacosamide and 8 g of lamotrigine during a suicide attempt. He developed generalized tonic-clonic seizure." "status epilepticus in a patient with atypical left temporal lobe epilepsy caused by toxic doses of lacosamide and lamotrigine." Deslandes G, et al. Status epilepticus following self-poisoning of lacosamide and lamotrigine: A case report with follow-up of drug serum concentrations.