Abstracts

Rationale: Refractory status epilepticus (RSE) is a life-threatening neurologic emergency with high morbidity and mortality requiring prompt neurointensive care. To date, established treatment paradigms include first generation antiepileptic drugs (AED) and narcotics. Lacosamide (LCM) is a new broad spectrum AED with a dual mode of action, holding promises as a potent treatment option for RSE. However, high-class evidence regarding safety and efficacy in treatment of RSE is lacking. The objective of the study was to evaluate the safety and efficacy of i.v. administered LCM as an add-on treatment in patients with RSE Methods: To evaluate the safety and efficacy of i.v. administered LCM as an add-on treatment in patients with RSE. Medical chart review was performed of all consecutive patients treated for RSE between January 2005 and December 2011 at the intensive care units of the University Hospital Basel (Switzerland). Results: 111 of 260 (42.7%) patients with SE developed RSE of which 59 (53.2% of RSE) consecutive patients were treated with i.v. LCM. In patients with LCM RSE could be terminated significantly more often than in patients without LCM (OR 3.91, p=0.015) and mortality was significant lower (OR 0.37, p=0.014), even when adjusted for age, resuscitation and stroke (OR 3.73, p=0.04; OR 0.33, p=0.018). There were no serious adverse events due to antiepileptic treatment. Conclusions: Patients with i.v. LCM had significant decreased mortality and more frequent cessation of RSE compared to patients without LCM after adjusting for potential confounders. LCM was well tolerated and safe in this cohort of patients with severe RSE. Prospective studies are warranted to further strengthen evidence of efficacy, safety and tolerability of LCM for the treatment of RSE.