Abstracts

Rationale:
Nonconvulsive status epilepticus (NCSE) is a subset of status epilepticus (SE) characterized by behavioral changes or cognitive impairment that is associated with poor prognosis due to neuronal death 1,2.  Current first and second line treatments consist of both sedating and non-sedating anti-epileptic drugs (AEDs) which are ineffective in up to 40% of cases3–6.  Furthermore, these AEDs are associated with a myriad of drug interactions and high rates of ICU admission6.  Lacosamide and Levetiracetam are relatively novel non-sedating AED’s with very few clinically relevant drug interactions6.  Studies investigating Lacosamide and Levetiracetam for the treatment of NCSE have consistently demonstrated promising efficacy, but the quantity of research has been lacking.  The objective of this study is to assess and compare the efficacy of IV lacosamide and levetiracetam when used in early treatment of NCSE utilizing a cohort of patients that is larger than any known single-center study.
Method:
Investigation was conducted via retrospective electronic medical record review of patients admitted at Miami Valley Hospital who received a diagnosis of NCSE between 2012-2016 and were treated with lacosamide or levetiracetam. A total of 66 patients treated with lacosamide and 33 patients with levetiracetam were identified for analysis. Study compared efficacy of NCSE treatment for both drugs and whether standard doses of Lacosamide 200-400mg IV bolus/Levetiracetam 500mg BID impacted treatment response.
Results:
When given at a therapeutic dose (200-400 IV bolus), lacosamide was shown to be more effective than levetiracetam (500mg) when given as a first dose with a p-value= 0.0003 using a chi-square test. In addition, lacosamide was also shown to be more effective as a second dose (p-value= 0.0009) but levetiracetam was more effective as a third medication administered (p-value= 0.005). Overall, clinical response to lacosamide was more effective as a first administered medication at p< 0.001. In contrast, levetiracetam administered as the third medication showed better clinical response than lacosamide p< 0.001. Of note, mean EEG monitoring time was longer at 3.91 days for lacosamide compared to 1.52 days for levetiracetam with a p-value of < 0.001. The two treatment groups did not show a significant difference in the duration of hospital stay.
Conclusion:
Overall this study showed lacosamide was more effective than levetiracetam when given earlier in the treatment of NCSE as the first medication administered. However, levetiracetam was found to be more effective when given as a third line agent or later. Our study shows lacosamide to be valid as a therapeutic option in the treatment of NCSE as compared with levetiracetam.
Funding:
:N/A