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Hidalgo de la Cruz M, Miranda Acuña JA, Luque Buzo E, Chavarria Cano B, Esteban de Antonio E, Prieto Montalvo J, Galiano Fragua ML, Massot-Tarrús A. Status epilepticus management and mortality risk factors: A retrospective study. Neurologia 2022; 37:532-542. [PMID: 31771778 DOI: 10.1016/j.nrl.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/20/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Status epilepticus (SE) is a neurological emergency with relatively high mortality rates. In this study, we analysed the management of SE and identified mortality risk factors that may be addressed with educational interventions or modifications to hospital protocols. METHODS In this retrospective study, we analysed demographic, treatment, and outcome data from 65 patients (mean age, 59 years [range, 44.5-77]; 53.8% women) who were admitted to our tertiary hospital during an 18-month period and met the 2015 International League Against Epilepsy criteria for SE. RESULTS Thirty patients (46.2%) had history of epilepsy. The most frequent causes of SE were cerebrovascular disease (27.7%) and systemic infection (16.9%). The following deviations were observed in the administration of the antiepileptic drugs: benzodiazepines were used as first option in only 33 (50.8%) patients; the combination of 2 benzodiazepines was recorded in 7 cases (10.8%); and lacosamide was used as an off-label drug in 5 patients (7.7%). Electroencephalography studies were performed in only 26 patients (40%); and only 5 studies (7.7% of patients) were performed within 12 hours of seizure onset. The mortality rate was 21.5%. Acute stroke and cerebrovascular complications were associated with higher mortality rates, while previous history of epilepsy and admission to intensive care were related to better prognosis (P <.05). CONCLUSIONS To improve SE management and reduce mortality rates, training activities targeting emergency department physicians should be implemented, together with elective intensive care admission for patients with multiple mortality risk factors (eg, absence of history of epilepsy, acute stroke, or cardiovascular complications).
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Affiliation(s)
- M Hidalgo de la Cruz
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - J A Miranda Acuña
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Luque Buzo
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - B Chavarria Cano
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - E Esteban de Antonio
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Prieto Montalvo
- Servicio de Neurofisiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M L Galiano Fragua
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - A Massot-Tarrús
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Hidalgo de la Cruz M, Miranda Acuña J, Luque Buzo E, Chavarria Cano B, Esteban de Antonio E, Prieto Montalvo J, Galiano Fragua M, Massot-Tarrús A. Status epilepticus management and mortality risk factors: a retrospective study. NEUROLOGÍA (ENGLISH EDITION) 2022; 37:532-542. [DOI: 10.1016/j.nrleng.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/20/2019] [Indexed: 10/20/2022] Open
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Abstract
PURPOSE The objective of our study was to evaluate the relationship between the loading dose and efficacy of lacosamide (LCM), when used in seizure clusters (SCs). METHODS A cohort of patients with SC treated with intravenous (IV)-LCM between September 2017 and September 2019 was retrospectively examined. Demographic data, type of seizure emergency, etiology, response rate, previous oral antiepileptic drugs used, total LCM loading dose, and side effects were reviewed. RESULTS Thirty-nine cases of epileptic emergencies treated with IV LCM were collected. The mean age was 59.25 years (18-88 years), and the median loading dose was 136.5 mg (100-300 mg) with a response rate in the whole population of 29.2%. Nine patients received a loading dose of 200 to 300 mg, and their response rate was 89%. Common side effects (drowsiness and dizziness) were mild. No electrocardiogram changes or other cardiovascular side effects, or unexpected side effects were seen. CONCLUSIONS In adults with SC, a loading dose of IV LCM of 200 mg or more achieved 89% response rate in this cohort. Loading doses of less than 300 mg caused mild side effects only.
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Treatment of established status epilepticus in the elderly - a study protocol for a prospective multicenter double-blind comparative effectiveness trial (ToSEE). BMC Neurol 2020; 20:438. [PMID: 33272223 PMCID: PMC7713039 DOI: 10.1186/s12883-020-02001-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Status epilepticus (SE) is a common neurological emergency condition that especially affects the elderly and old population. Older people with SE frequently have non-convulsive SE (NCSE) and are also at special risk of suffering a poor outcome. The application of benzodiazepines fails to control SE in about one third of the cases. For benzodiazepine refractory SE (BRSE) in elderly, there is little evidence that would justify the choice of one of the commonly used antiepileptic drugs. The present study aims to generate evidence for the treatment of BRSE in this age group. METHODS We will conduct a prospective, randomized, double-blind comparative effectiveness study in more than twenty hospitals in Germany over a four-year period. Four hundred and seventy-seven elderly patients (≥ 65 years old) diagnosed with BRSE will be allocated by 1:1 randomization to receive either levetiracetam or valproate. All types of SE will be considered. For the diagnosis NCSE a verification by EEG is required. Levetiracetam or valproate will be administered in one single infusion. The primary endpoint is the stable cessation of ictal activity 15 min after the start of infusion persisting for the following 45 min of observation. EEG recording is maintained over the whole observation period, clinical examinations are conducted in predefined intervals. In case of treatment success patients and study staff remain blinded until 60 min after the start of the infusion. Adverse events will be recorded until the end of the study. EEG data will be reviewed by two external independent experts. To obtain data about the further treatment of SE, intrahospital complications and the functional outcome in the short term the study participants will be observed until the day of discharge or day 30 whichever is earliest. DISCUSSION ToSEE is the first study which shall deliver evidence for the SE-therapy in the elderly and old population in a controlled prospective comparator study. By design it also shall collect information about therapy regimes and outcome aspects of this disease. TRIAL REGISTRATION The trial has been registered at the German Clinical Trials Register on 3 July, 2020 ( DRKS00022308 , https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022308 ).
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Meziane-Tani A, Foreman B, Mizrahi MA. Status Epilepticus: Work-Up and Management in Adults. Semin Neurol 2020; 40:652-660. [PMID: 33176372 DOI: 10.1055/s-0040-1719112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Status epilepticus is one of the most common neurological emergencies and is likely to have increasing prevalence in coming years given an aging "baby boomer" population in the United States. Because status epilepticus is associated with significant morbidity and mortality, identification and treatment are paramount. Care should be taken to exclude nonorganic mimics and infectious and metabolic causes. Status epilepticus can be classified into stages with associated recommendations for escalation in therapy, increasing from push-dose benzodiazepines to continuous anesthetic infusions and other nontraditional therapies. Concurrent electroencephalogram monitoring helps to identify, localize, and assess resolution of ictal patterns alongside antiseizure drug administration. A protocol is proposed for the management of status epilepticus in a step-wise fashion.
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Affiliation(s)
- Assia Meziane-Tani
- Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Brandon Foreman
- Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Moshe A Mizrahi
- Division of Neurocritical Care, Department of Neurology, University of Cincinnati Academic Health Center, Cincinnati, Ohio
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VanHaerents S, Gerard EE. Epilepsy Emergencies: Status Epilepticus, Acute Repetitive Seizures, and Autoimmune Encephalitis. Continuum (Minneap Minn) 2019; 25:454-476. [PMID: 30921018 DOI: 10.1212/con.0000000000000716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW This article reviews epilepsy emergencies, including status epilepticus, acute repetitive seizures, autoimmune encephalitis, and the current perspective on their diagnosis and treatment. RECENT FINDINGS Recent guidelines on the treatment of status epilepticus from the Neurocritical Care Society in 2012 and the American Epilepsy Society in 2016 highlight areas of consensus in the treatment of status epilepticus as well as areas of uncertainty. The TRENdS (Treatment of Recurrent Electrographic Nonconvulsive Seizures) trial is the first prospective randomized clinical trial to evaluate the efficacy of IV antiseizure medications in controlling nonconvulsive seizures on continuous EEG. It demonstrated that IV lacosamide is noninferior to fosphenytoin in this setting. Autoimmune encephalitis is an increasingly recognized cause of new-onset seizures or status epilepticus. Recently described scoring systems, the Antibody Prevalence in Epilepsy score and the Response to Immunotherapy in Epilepsy score, can help in the assessment of autoimmune encephalitis. SUMMARY Status epilepticus, acute repetitive seizures, and autoimmune encephalitis are neurologic emergencies. For all these conditions, rapid and appropriate treatment may influence patient prognosis and mitigate neuronal injury. For convulsive status epilepticus, there is reasonable consensus on the initial steps that need to be taken. There is less agreement about the management of acute repetitive seizures and nonconvulsive status epilepticus. An increasingly recognized etiology of status epilepticus is autoimmune encephalitis, which may not be as rare as previously thought.
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Solanki P, Coppler PJ, Kvaløy JT, Baldwin MA, Callaway CW, Elmer J. Association of antiepileptic drugs with resolution of epileptiform activity after cardiac arrest. Resuscitation 2019; 142:82-90. [PMID: 31325554 PMCID: PMC7286066 DOI: 10.1016/j.resuscitation.2019.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION We tested the impact of antiepileptic drug (AED) administration on post-cardiac arrest epileptiform electroencephalographic (EEG) activity. METHODS We studied an observational cohort of comatose subjects treated at a single academic medical center after cardiac arrest from September 2010 to January 2018. We aggregated the observed EEG patterns into 5 categories: suppressed; discontinuous background with superimposed epileptiform activity; discontinuous background without epileptiform features; continuous background with epileptiform activity; and continuous background without epileptiform activity. We calculated overall probabilities of transitions between EEG states in a multistate model, then used Aalen's additive regression to test if AEDs or hypothermia are associated with a change in these probabilities. RESULTS Overall, 828 subjects had EEG-monitoring for 42,840 h with a median of 40 [IQR 23-64] h per subject. Among patients with epileptiform findings on initial monitoring, 50% transitioned at least once to a non-epileptiform, non-suppressed state. By contrast, 19% with non-epileptiform initial activity transitioned to an epileptiform state at least once. Overall, 568 (78%) patients received at least one AED. Among patients with continuous EEG background activity, valproate, levetiracetam and lower body temperature were each associated with an increased probability of transition from epileptiform states to non-epileptiform states, where patients with discontinuous EEG background activity no agent linked to an increased probability of transitioning from epileptiform states. CONCLUSION After cardiac arrest, the impact of AEDs may depend on the presence of continuous cortical background activity. These data serve to inform experimental work to better define the opportunities to improve neurologic care post-cardiac arrest.
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Affiliation(s)
- Pawan Solanki
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick J Coppler
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jan Terje Kvaløy
- Department of Mathematics and Physics, Faculty of Science and Technology, University of Stavanger, Stavanger, Norway
| | - Maria A Baldwin
- Department of Neurology, Pittsburgh VA Medical Center, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
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Husain AM, Lee JW, Kolls BJ, Hirsch LJ, Halford JJ, Gupta PK, Minazad Y, Jones JM, LaRoche SM, Herman ST, Swisher CB, Sinha SR, Palade A, Dombrowski KE, Gallentine WB, Hahn CD, Gerard EE, Bhapkar M, Lokhnygina Y, Westover MB. Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures. Ann Neurol 2019; 83:1174-1185. [PMID: 29733464 DOI: 10.1002/ana.25249] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The optimal treatment of nonconvulsive seizures in critically ill patients is uncertain. We evaluated the comparative effectiveness of the antiseizure drugs lacosamide (LCM) and fosphenytoin (fPHT) in this population. METHODS The TRENdS (Treatment of Recurrent Electrographic Nonconvulsive Seizures) study was a noninferiority, prospective, multicenter, randomized treatment trial of patients diagnosed with nonconvulsive seizures (NCSs) by continuous electroencephalography (cEEG). Treatment was randomized to intravenous (IV) LCM 400mg or IV fPHT 20mg phenytoin equivalents/kg. The primary endpoint was absence of electrographic seizures for 24 hours as determined by 1 blinded EEG reviewer. The frequency with which NCS control was achieved in each arm was compared, and the 90% confidence interval (CI) was determined. Noninferiority of LCM to fPHT was to be concluded if the lower bound of the CI for relative risk was >0.8. RESULTS Seventy-four subjects were enrolled (37 LCM, 37 fPHT) between August 21, 2012 and December 20, 2013. The mean age was 63.6 years; 38 were women. Seizures were controlled in 19 of 30 (63.3%) subjects in the LCM arm and 16 of 32 (50%) subjects in the fPHT arm. LCM was noninferior to fPHT (p = 0.02), with a risk ratio of 1.27 (90% CI = 0.88-1.83). Treatment emergent adverse events (TEAEs) were similar in both arms, occurring in 9 of 35 (25.7%) LCM and 9 of 37 (24.3%) fPHT subjects (p = 1.0). INTERPRETATION LCM was noninferior to fPHT in controlling NCS, and TEAEs were comparable. LCM can be considered an alternative to fPHT in the treatment of NCSs detected on cEEG. Ann Neurol 2018;83:1174-1185.
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Affiliation(s)
- Aatif M Husain
- Department of Neurology, Duke University Medical Center, Durham, NC.,Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC.,Duke Clinical Research Institute, Durham, NC
| | - Jong W Lee
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Bradley J Kolls
- Department of Neurology, Duke University Medical Center, Durham, NC.,Duke Clinical Research Institute, Durham, NC
| | - Lawrence J Hirsch
- Department of Neurology, Yale University School of Medicine, New Haven, CT
| | - Jonathan J Halford
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | - Puneet K Gupta
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Yafa Minazad
- Neurosciences Center, Huntington Memorial Hospital, Pasadena, CA
| | | | - Suzette M LaRoche
- Department of Neurology, Mission Health, Asheville, NC.,Department of Neurology, Emory University, Atlanta, GA
| | - Susan T Herman
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Saurabh R Sinha
- Department of Neurology, Duke University Medical Center, Durham, NC.,Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC
| | - Adriana Palade
- Department of Neurology, University of Louisville, Louisville, KY
| | - Keith E Dombrowski
- Department of Neurology, Duke University Medical Center, Durham, NC.,Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC
| | - William B Gallentine
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC
| | - Cecil D Hahn
- Division of Neurology, Hospital for Sick Children and Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth E Gerard
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | | | - Yuliya Lokhnygina
- Duke Clinical Research Institute, Durham, NC.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Gaínza-Lein M, Fernández IS, Ulate-Campos A, Loddenkemper T, Ostendorf AP. Timing in the treatment of status epilepticus: From basics to the clinic. Seizure 2019; 68:22-30. [DOI: 10.1016/j.seizure.2018.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/18/2018] [Accepted: 05/29/2018] [Indexed: 02/07/2023] Open
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Shorvon S, Trinka E. Regulatory aspects of status epilepticus. Epilepsia 2018; 59 Suppl 2:128-134. [DOI: 10.1111/epi.14547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2018] [Indexed: 12/28/2022]
Affiliation(s)
| | - Eugen Trinka
- Department of Neurology; Paracelsus Medical University; Christian Doppler Medical Center; Salzburg Austria
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Abstract
PURPOSE OF REVIEW Status epilepticus has a high morbidity and mortality. There are little definitive data to guide management; however, new recent data continue to improve understanding of management options of status epilepticus. This review examines recent advancements regarding the critical care management of status epilepticus. RECENT FINDINGS Recent studies support the initial treatment of status epilepticus with early and aggressive benzodiazepine dosing. There remains a lack of prospective randomized controlled trials comparing different treatment regimens. Recent data support further study of intravenous lacosamide as an urgent-control therapy, and ketamine and clobazam for refractory status epilepticus. Recent data support the use of continuous EEG to help guide treatment for all patients with refractory status epilepticus and to better understand epileptic activity that falls on the ictal-interictal continuum. Recent data also improve our understanding of the relationship between periodic epileptic activity and brain injury. SUMMARY Many treatments are available for status epilepticus and there are much new data guiding the use of specific agents. However, there continues to be a lack of prospective data supporting specific regimens, particularly in cases of refractory status epilepticus.
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Husain AM. Ellen Grass Memorial Lecture: Clinical Neurophysiology in the Treatment of Disease. Neurodiagn J 2018; 58:203-212. [PMID: 31307328 DOI: 10.1080/21646821.2018.1539598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clinical neurophysiology has a long-standing history and value in the diagnosis of neurologic diseases. Because of their unique ability to assess physiology and function of the nervous system, electroencephalography (EEG), evoked potentials, electromyography (EMG), and polysomnography have long been used in the diagnostic evaluation of epilepsies, demyelinating disorders, neuromuscular disorders, sleep disorders, and other diseases affecting the central and peripheral nervous systems. The role of these tests and clinical neurophysiology in general has usually ended upon diagnosis. New applications of these trusted techniques are changing old perceptions. Continuous EEG monitoring has found new value in not only diagnosis but also in treatment of nonconvulsive seizures and status epilepticus. Visual evoked potentials have been shown to be a biomarker for assessment of demyelination and remyelination associated with treatment of multiple sclerosis. Various EMG techniques can be used to independently assess improvement or otherwise of many neuromuscular diseases. The use of these techniques in the treatment of various neurologic disorders is the next frontier for clinical neurophysiology.
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Affiliation(s)
- Aatif M Husain
- a Department of Neurology , Duke University Medical Center , Durham , North Carolina.,b Neuroscience Medicine , Duke Clinical Research Institute , Durham , North Carolina.,c Neurodiagnostic Center , Veterans Affairs Medical Center , Durham , North Carolina
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Perrenoud M, André P, Alvarez V, Stähli C, Decosterd LA, Rossetti AO, Novy J. Intravenous lacosamide in status epilepticus: Correlation between loading dose, serum levels, and clinical response. Epilepsy Res 2017. [PMID: 28622537 DOI: 10.1016/j.eplepsyres.2017.05.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intravenous lacosamide (LCM) is increasingly used in the treatment of status epilepticus (SE), but optimal loading dose and target serum levels are unclear. We analysed the correlation between LCM serum levels after intravenous loading dose and clinical response. MATERIALS AND METHODS Retrospective study in two centres from December 2014 to May 2016 including consecutive SE patients treated with LCM, in which trough serum levels after intravenous loading dose were available. Trough levels were correlated with the loading dose and the clinical response, defined as LCM introduction terminating SE without the need of further treatment. Correlations were adjusted for other SE characteristics. RESULTS Among 40 patients, 16 (40%) responded to LCM. LCM serum concentrations within the reference interval (10-20mg/l) were associated with loading doses of >9mg/kg (p=0.003; χ2). However, we observed no difference between LCM serum levels in responders (median 10.4mg/l) versus non-responders (median 9.5mg/l; p=0.36; U test), even after adjusting for other predictors of clinical outcome (SE severity, aetiology, and number of previous treatment). DISCUSSION High intravenous LCM loading doses (>9mg/kg) were associated with serum levels within the reference interval, there was however no correlation with the clinical response. Prospective studies are needed to evaluate the benefit of increasing the LCM loading dose in SE.
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Affiliation(s)
- Matthieu Perrenoud
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland
| | - Pascal André
- Laboratoy of Clinical Pharmacology, Department of Laboratories, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland
| | - Vincent Alvarez
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland; Neurology Service, Hôpital de Sion, Switzerland
| | - Christine Stähli
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland
| | - Laurent A Decosterd
- Laboratoy of Clinical Pharmacology, Department of Laboratories, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland
| | - Andrea O Rossetti
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland
| | - Jan Novy
- Neurology Service, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Switzerland.
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Strzelczyk A, Zöllner JP, Willems LM, Jost J, Paule E, Schubert-Bast S, Rosenow F, Bauer S. Lacosamide in status epilepticus: Systematic review of current evidence. Epilepsia 2017; 58:933-950. [PMID: 28295226 DOI: 10.1111/epi.13716] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The intravenous formulation of lacosamide (LCM) and its good overall tolerability and safety favor the use in status epilepticus (SE). The aim of this systematic review was to identify and evaluate studies reporting on the use of LCM in SE. METHODS We performed a systematic literature search of electronic databases using a combined search strategy from 2008 until October 2016. Using a standardized assessment form, information on the study design, methodologic framework, data sources, efficacy, and adverse events attributed to LCM were extracted from each publication and systematically reported. RESULTS In total, 522 SE episodes (51.7% female) in 486 adults and 36 children and adolescents were evaluated with an overall LCM efficacy of 57%. Efficacy was comparable between use in nonconvulsive (57%; 82/145) and generalized-convulsive (61%; 30/49; p = 0.68) SE, whereas overall success rate was better in focal motor SE (92%; 34/39, p = 0.013; p < 0.001). The efficacy with later positioning of LCM decreased from 100% to 20%. The main adverse events during treatment of SE are dizziness, abnormal vision, diplopia, and ataxia. Overall, lacosamide is well tolerated and has no clinically relevant drug-drug interactions. SIGNIFICANCE The available data regarding the use of LCM in SE are promising, with a success rate of 57%. The strength of LCM is the lack of interaction potential and the option for intravenous use in emergency situations requiring rapid uptitration.
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Affiliation(s)
- Adam Strzelczyk
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Johann Philipp Zöllner
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Laurent M Willems
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Julie Jost
- Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Esther Paule
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Susanne Schubert-Bast
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.,Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
| | - Sebastian Bauer
- Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany.,Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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Husain AM. Clarity in EEG diagnosis of non-convulsive status epilepticus. Lancet Neurol 2016; 15:1001-3. [DOI: 10.1016/s1474-4422(16)30172-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
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Lacosamide in patients with temporal lobe epilepsy: An observational multicentric open-label study. Epilepsy Behav 2016; 58:111-4. [PMID: 27064831 DOI: 10.1016/j.yebeh.2016.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy and tolerability of lacosamide (LCM) both as add-on therapy and monotherapy in patients with temporal lobe epilepsy (TLE) based on an observational, prospective, multicenter study. METHODS We enrolled 100 patients (mean age: 43.4±12.53years, 57 females) with nonlesional TLE and TLE with hippocampal sclerosis (HS) that did not respond to the first drug and who were referred to epilepsy centers of the University of Catanzaro, University of Palermo, IRCSS Neuromed of Pozzilli, and Otto-von-Guericke University of Magdeburg. In this open-label, multicenter trial, patients were initiated on oral LCM as add-on therapy to first AED monotherapy or as a later add-on to two concomitant AEDs. Seizure frequency changes and adverse events were recorded for at least six months after LCM was added. RESULTS Fourteen patients dropped out because of positive MRI findings other than HS. Patients received LCM at 200-400mg/day. Fifty-eight out of these 86 patients with seizures that were previously drug-resistant had reduced seizure frequency after introduction of LCM. Forty-five out of 86 patients were classified as responders (12 were seizure-free, 33 achieved a reduction >50%). Interestingly, five patients out of 86 achieved seizure freedom for at least one year and progressively switched to monotherapy with LCM, and all five remained seizure-free at follow-up (6-48months). CONCLUSIONS Our results may suggest that LCM at doses of 200 to 400mg/day reduces seizure frequency in adults with TLE regardless of the presence of HS, and that it may be considered as a first add-on treatment for patients with pharmacoresistant TLE.
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Falco-Walter JJ, Bleck T. Treatment of Established Status Epilepticus. J Clin Med 2016; 5:jcm5050049. [PMID: 27120626 PMCID: PMC4882478 DOI: 10.3390/jcm5050049] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 03/29/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
Status epilepticus is the most severe form of epilepsy, with a high mortality rate and high health care costs. Status epilepticus is divided into four stages: early, established, refractory, and super-refractory. While initial treatment with benzodiazepines has become standard of care for early status epilepticus, treatment after benzodiazepine failure (established status epilepticus (ESE)) is incompletely studied. Effective treatment of ESE is critical as morbidity and mortality increases dramatically the longer convulsive status epilepticus persists. Phenytoin/fosphenytoin, valproic acid, levetiracetam, phenobarbital, and lacosamide are the most frequently prescribed antiseizure medications for treatment of ESE. To date there are no class 1 data to support pharmacologic recommendations of one agent over another. We review each of these medications, their pharmacology, the scientific evidence in support and against each in the available literature, adverse effects and safety profiles, dosing recommendations, and limitations of the available evidence. We also discuss future directions including the established status epilepticus treatment trial (ESETT). Substantial further research is urgently needed to identify these patients (particularly those with non-convulsive status epilepticus), elucidate the most efficacious antiseizure treatment with head-to-head randomized prospective trials, and determine whether this differs for convulsive vs. non-convulsive ESE.
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Affiliation(s)
- Jessica J Falco-Walter
- Department of Neurology, Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA.
| | - Thomas Bleck
- Department of Neurology, Rush University Medical Center, 1725 West Harrison Street, Suite 885, Chicago, IL 60612, USA.
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