Efficacy and safety of lacosamide in the treatment of status epilepticus in a patient with comorbidities
Keywords:
Status epilepticus, lacosamide, comorbidities, AEDsAbstract
Efficacy, safety and tolerability of lacosamide in the treatment of status epilepticus are well described. However, other evidence of its pharmacologic profile in elderly patients with other comorbidities seems warranted. We describe the case of an 80 year-old woman with an history of arterial hypertension, ischemic cardiomyopathy, COPD, CKD, previous laryngeal cancer, a stoma positioning for diverticular disease and previous surgery for a left frontal meningioma. Since then, the patient developed focal epilepsy and she was on levetiracetam and valproic acid therapy. The patient was admitted to our department for a focal status epilepticus characterized by non-fluent aphasia and right facio-brachial clonic movements. She also presented with aspiration pneumonia and started intravenous antibiotic treatment. After failure of a first-line antiepileptic drug, lacosamide intravenous treatment was started, with complete reversal of the clinical picture. EEG then showed focal slow waves mixed to interictal epileptiform discharges over the left fronto-temporal regions. The patient was then discharged home with an oral lacosamide treatment and at 3 months she was seizure-free. Our case report confirms the efficacy of lacosamide in status epilepticus, highlighting its safety and tolerability in an elderly and fragile patient with multiple comorbidities and drug therapy.
References
Lowenstein, D. H., Rossetti, A. O., Shinnar, S., Trinka, E., Shorvon, S., Cock, H., … Hesdorffer, D. (2015). A definition and classification of status epilepticus - Report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia, 56(10), 1515–1523. https://doi.org/10.1111/epi.13121
Leppik, I. E. (2018). Status epilepticus in the elderly. Epilepsia, 59(March), 140–143. https://doi.org/10.1111/epi.14497
Fountain, N. B., Krauss, G., Isojarvi, J., Dilley, D., Doty, P., & Rudd, G. D. (2013). Safety and tolerability of adjunctive lacosamide intravenous loading dose in lacosamide-naive patients with partial-onset seizures. Epilepsia, 54(1), 58–65. https://doi.org/10.1111/j.1528-1167.2012.03543.x
Halász, P., Kälviäinen, R., Mazurkiewicz-Beldzińska, M., Rosenow, F., Doty, P., Hebert, D., & Sullivan, T. (2009). Adjunctive lacosamide for partial-onset seizures: Efficacy and safety results from a randomized controlled trial. Epilepsia, 50(3), 443–453. https://doi.org/10.1111/j.1528-1167.2008.01951.x
Baulac, M., Rosenow, F., Toledo, M., Terada, K., Li, T., De Backer, M., … Brock, M. (2017). Efficacy, safety, and tolerability of lacosamide monotherapy versus controlled-release carbamazepine in patients with newly diagnosed epilepsy: a phase 3, randomised, double-blind, non-inferiority trial. The Lancet Neurology, 16(1), 43. https://doi.org/10.1016/S1474-4422(16)30292-7
Alvarez, V., Januel, J. M., Burnand, B., & Rossetti, A. O. (2012). Role of comorbidities in outcome prediction after status epilepticus. Epilepsia, 53(5), 89–92. https://doi.org/10.1111/j.1528-1167.2012.03451.x
Aukland, P., Lando, M., Vilholm, O., Christiansen, E. B., & Beier, C. P. (2016). Predictive value of the Status Epilepticus Severity Score (STESS) and its components for long-term survival. BMC Neurology, 16(1), 1–9. https://doi.org/10.1186/s12883-016-0730-0
Rossetti, A. O., Hurwitz, S., Logroscino, G., & Bromfield, E. B. (2006). Prognosis of status epilepticus: Role of aetiology, age, and consciousness impairment at presentation. Journal of Neurology, Neurosurgery and Psychiatry, 77(5), 611–615. https://doi.org/10.1136/jnnp.2005.080887
Bauer, S., Willems, L. M., Paule, E., Petschow, C., Zöllner, J. P., Rosenow, F., & Strzelczyk, A. (2017). The efficacy of lacosamide as monotherapy and adjunctive therapy in focal epilepsy and its use in status epilepticus: Clinical trial evidence and experience. Therapeutic Advances in Neurological Disorders, 10(2), 103–126. https://doi.org/10.1177/1756285616675777
Strzelczyk, A., Zöllner, J. P., Willems, L. M., Jost, J., Paule, E., Schubert-Bast, S., … Bauer, S. (2017). Lacosamide in status epilepticus: Systematic review of current evidence. Epilepsia, 58(6), 933–950. https://doi.org/10.1111/epi.13716
Rainesalo, S., Mäkinen, J., Raitanen, J., & Peltola, J. (2017). Clinical management of elderly patients with epilepsy; the use of lacosamide in a single center setting. Epilepsy and Behavior, 75, 86–89. https://doi.org/10.1016/j.yebeh.2017.07.045
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