Intravenous Lacosamid in refractory convulsive status epilepticus

Introduction: Lacosamid is a new antiepileptic drug, used in patients older than 16 years as an add-on medication for focal seizures. It has been used succesfully in adult patients with refractory convulsive status epilepticus. There are no data about the use in children. We present two cases in which we used Lacosamid in status epilepticus.

Case 1: patient with Alpers-Syndrom

Our patient showed a mild psychomotor retardation at age 12 months. Later she developed a progressiv attaxia. At age 42 months she was admitted to our intensive care unit in a refractory convulsive status epilepticus. Under the usual medication convulsions only stopped by deep propofol sedation, by reduction of propofol convulsion propagated from the left arm to the rest of the body. After giving Midazolam, Levetirazetam, Clonazepam, Clobazam, Diazepam, Phenobarbital, Phenhydan, Valproat, Corticosteroids without effect we gave Lacosamid (Vimpat®) in a dose of 2×100mg/d. Propofol and Phenobarbital could be stopped and intubation could be ended. The child still showed several myoclonias but no generalized convulsions.

Case 2: Patient with Lennox-Gastaut-Syndrom after prenatal intracerebral hemorrhage.

The patient developed a therapy resistant BNS-epilepsy at the age of 6 months, later on a Lennox-Gastaut-Syndrom. At the age of 4 years he was admitted to ouer intensive care unit because of a pneumonia and needed artificial respiration. At that time he had Valproat as antiepileptic medication. After changing antibiotics to Meronem he had an increase in seizure activity. We gave Lacosamid (Vimpat®) in a dose of 2×100mg/d, then 2×200mg/d. We saw no adverse effects, but convulsions didn't stop. The cause of the exarbation of seizures probably was the enzyme induction of Meronem.

Conclusion: First experience with Lacosamid shows it as an additional option in status epilepticus.