Status epilepticus following self-poisoning of lacosamide and lamotrigine: A case report with follow-up of drug serum concentrations

Deslandes, Guillaume; Bouquié, Regis; Lorber, Julien; Bruneau, Chloé; Grégoire, Matthieu; Grison-Hernando, Hélène; Pineau, Alain; Monteil-Ganière, Catherine; Azoulay, Claudine; Dailly, Éric; Villers, D.; Harry, P.; Jolliet, Pascale

doi:10.1016/j.toxac.2015.02.002

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…There is one case report of status epilepticus in a patient with epilepsy who overdosed on lacosamide and lamotrigine. Peak plasma concentration of lacosamide occurred at 10 h postingestion and was 53.9 mg/L (approximate therapeutic range 6-18 mg/L) [30]. Status epilepticus has also been reported in overdose in epilepsy patients taking other anticonvulsants either therapeutically or as co-ingestants [15,31].…”

Section: Third-generation Anticonvulsant Drugsmentioning

confidence: 99%

The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs

LaPenna

Tormoehlen

2017

J. Med. Toxicol.

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Epilepsy is a neurologic disorder affecting approximately 50 million people worldwide, or about 0.7% of the population [1]. Thus, the use of anticonvulsant drugs in the treatment of epilepsy is common and widespread. There are three generations of anticonvulsant drugs, categorized by the year in which they were developed and released. The aim of this review is to discuss the pharmacokinetics, drug-drug interactions, and adverse events of the third generation of anticonvulsant drugs. Where available, overdose data will be included. The pharmacokinetic properties of third-generation anticonvulsant drugs include relatively fewer drug-drug interactions, as well as several unique and life-threatening adverse events. Overdose data are limited, so thorough review of adverse events and knowledge of drug mechanism will guide expectant management of future overdose cases. Reporting of these cases as they occur will be necessary to further clarify toxicity of these drugs.

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Section: Third-generation Anticonvulsant Drugsmentioning

confidence: 99%

The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs

LaPenna

Tormoehlen

2017

J. Med. Toxicol.

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“…However, maybe due to our small sample size, this difference did not reach statistical significance. When considering data from published case reports, seizures were a common reported clinical manifestation 9,[13][14][15][16] ; in 2 cases, the patients also developed status epilepticus. Status epilepticus did not occur in any of our patients.…”

Section: Thirtymentioning

confidence: 99%

Clinical characteristics of acute lacosamide poisoning: Pavia Poison Control Centre experience

Bernasconi,

Schicchi,

Petrolini

et al. 2023

Brit J Clinical Pharma

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AimLacosamide is a third‐generation antiepileptic drug used as adjunctive therapy for partial seizures. Since its approval in 2008 very few cases of lacosamide overdose have been described in literature. The aim of our study was to evaluate clinical characteristics of acute lacosamide poisoning.MethodsA retrospective observational study was performed including all cases of acute lacosamide poisoning referred to Pavia Poison Control Centre from January 2012 to December 2021. For each patient age, sex, ingested dose, coingestants, clinical manifestations, treatment and outcome were collected.ResultsA total of 31 subjects (median age 39 years, [25th – 75th percentiles: 26.5‐46.5]; females 22/31) were included. The median lacosamide ingested dose was 1500 mg [650 – 2800]. In 35.5% of cases lacosamide was the single ingested substance, while in 64.5% co‐ingestants were also present. Co‐ingestants varied from a minimum of 1 to a maximum of 3, with the more common being benzodiazepines and valproic acid. Clinical manifestations were present in 87% patients the most common were: vomiting (29%); seizures (29%), coma (25.8%), drowsiness (25.8%), confusion (12.9%), agitation (12.9%), tachycardia (12.9%), tremors (9.7%), bradycardia (9.7%), headache (6.5%) and hypertension (3.2%). The median lacosamide ingested dose was significantly higher in patients that experienced coma compared to patient who did not (2800 mg vs. 800 mg; p=0.0082). Orotracheal intubation was necessary in 32.3% of patients. All patients fully recovered.ConclusionsLacosamide acute overdose may lead to a severe clinical picture. CNS symptoms predominated, particularly seizures and coma occurred in a high percentage of cases.

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Lacosamide/lamotrigine overdose

2016

Reactions Weekly

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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.

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Status epilepticus following self-poisoning of lacosamide and lamotrigine: A case report with follow-up of drug serum concentrations

Cited by 4 publications

References 6 publications

The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs

The Pharmacology and Toxicology of Third-Generation Anticonvulsant Drugs

Clinical characteristics of acute lacosamide poisoning: Pavia Poison Control Centre experience

Lacosamide/lamotrigine overdose

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