Epilepsy: intravenous Lacosamide in clinical practice


A study has evaluated the efficacy and tolerability of intravenous Lacosamide ( LCM-iv ) under routine conditions in daily clinical practice as a prospective registry.

Patients with any type of seizure or epilepsy syndrome were recruited in 16 neurological and neuropediatric centers in Germany if the treating physician decided to administer intravenous Lacosamide for any reason.
Observation time per patient was 10 days with daily documentation of intravenous Lacosamide administration, type and frequency of seizures, currently used drugs and doses, and adverse events.
Treatment efficacy, tolerability, and handling of intravenous Lacosamide were assessed using a five-step scale.

In 119 patients treating physicians classified epilepsies as focal in 66.1% and generalized in 17.4% ( 16.5% unclassifiable ). Most common etiologies of seizures were tumors ( 36.1% ) and cerebrovascular diseases ( 21.8% ).

Reasons for intravenous Lacosamide treatment included preparation for surgery ( 25.2% ), convulsive ( 24.4% ) and non-convulsive ( 18.5% ) status epilepticus, series of seizures ( 16.0% ), gastrointestinal causes ( 5.9% ), and acute seizures ( 4.2% ).

The median dose of intravenous Lacosamide was 300mg per day.

In 45 of 64 patients ( 70.3% ) with status epilepticus or series of seizures, epileptic activity ceased during observation time.

Five patients showed abnormalities in ECG prior to the infusion and one patient afterwards, but during infusion no abnormalities were reported.

Treating physicians rated efficacy and tolerability as very good or good in 77.6% and 93.1% of patients, respectively.

In conclusion, this large and independent multicenter registry on the use of intravenous Lacosamide in clinical practice has demonstrated that intravenous Lacosamide is well-tolerated and highly efficacious when given in emergency situations, including patients experiencing status epilepticus.
It is advisable to perform an electrocardiogram prior to intravenous Lacosamide administration. ( Xagena )

Lang N et al, Seizure 2016;39:5-9

XagenaMedicine_2016



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