Lacosamide for the Treatment of Refractory Status Epilepticus

OBJECTIVE: To evaluate current evidence for the use of lacosamide in the treatment of refractory status epilepticus. DATA SOURCES: Literature was accessed via PubMed (through July 2011) using the terms lacosamide and status epilepticus. STUDY SELECTION AND DATA EXTRACTION: All reports on the use of lacosamide in patients with status epilepticus were included for evaluation. Reviews and animal data were excluded. DATA SYNTHESIS: Treatment of status epilepticus is challenging, and most patients fail to respond to initial treatment. Recently, several reports have been published on the use of lacosamide for status epilepticus. Eleven reports (5 case reports and 6 case series) were identified. Lacosamide was credited with successful termination of status epilepticus in a majority of these reports. However, the data are weakened by the heterogeneity of the reports, their descriptive nature, and the common divergence from current recommendations for the treatment of status epilepticus. CONCLUSIONS: While lacosamide has been reported as an effective treatment for refractory status epilepticus, there is insufficient evidence for its routine use. For cases in which the risks associated with anesthetizing drugs are believed to outweigh the benefits, such as in complex partial status epilepticus, lacosamide may be a reasonable option after more established drug therapies fail.