Lacosamide in status epilepticus: Systematic review of current evidence

Authors

  • Adam Strzelczyk,

    Corresponding author
    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
    2. Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
    • Address correspondence to Adam Strzelczyk, Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, J. W. Goethe-University Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. E-mail: strzelczyk@med.uni-frankfurt.de

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    • Contributed equally.
  • Johann Philipp Zöllner,

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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    • Contributed equally.
  • Laurent M. Willems,

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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  • Julie Jost,

    1. Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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  • Esther Paule,

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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  • Susanne Schubert-Bast,

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
    2. Department of Neuropediatrics, Goethe-University, Frankfurt am Main, Germany
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  • Felix Rosenow,

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
    2. Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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  • Sebastian Bauer

    1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Goethe-University, Frankfurt am Main, Germany
    2. Epilepsy Center Hessen and Department of Neurology, Philipps-University, Marburg, Germany
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Summary

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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