Department of Neurology, Klinikum Osnabrück, Germany.
Acta Neurol Scand. 2011 Feb;123(2):137-41. doi: 10.1111/j.1600-0404.2010.01423.x. Epub 2010 Sep 26.
Treatment of established status epilepticus (SE) requires immediate intravenous anticonvulsant therapy. Currently used first-line drugs may cause potentially hazardous side effects. We aimed to assess the efficacy and safety of intravenous lacosamide (LCM) in SE after failure of standard treatment.
We retrospectively analyzed 39 patients (21 women, 18 men, median age 62 years) from the hospital databases of five neurological departments in Germany, Austria and Switzerland between September 2008 and January 2010 who were admitted in SE and received at least one dose of intravenous LCM.
Types of SE were generalized convulsive (n = 6), complex partial (n = 17) and simple partial (n = 16). LCM was administered after failure of benzodiazepins or other standard drugs in all but one case. Median bolus dose of LCM was 400 mg (range 200-400 mg), which was administered at 40-80 mg/min in those patients where infusion rate was documented. SE stopped after LCM in 17 patients, while 22 patients needed further anticonvulsant treatment. The success rate in patients receiving LCM as first or second drug was 3/5, as third drug 11/19, and as fourth or later drug 3/15. In five subjects, SE could not be terminated at all. No serious adverse events attributed to LCM were documented.
Intravenous LCM may be an alternative treatment for established SE after failure of standard therapy, or when standard agents are considered unsuitable.
治疗已确立的癫痫持续状态（SE）需要立即进行静脉抗惊厥治疗。目前使用的一线药物可能会引起潜在的危险副作用。我们旨在评估静脉用拉考酰胺（LCM）在标准治疗失败后治疗 SE 的疗效和安全性。
我们回顾性分析了 2008 年 9 月至 2010 年 1 月期间来自德国、奥地利和瑞士五家神经科医院数据库的 39 名患者（21 名女性，18 名男性，中位年龄 62 岁），这些患者患有 SE 并接受了至少一剂静脉用 LCM。
SE 的类型为全面性强直阵挛发作（n = 6）、复杂部分性发作（n = 17）和单纯部分性发作（n = 16）。除 1 例患者外，所有患者均在苯二氮䓬类药物或其他标准药物治疗失败后使用 LCM。LCM 的中位推注剂量为 400mg（范围 200-400mg），在有输注速度记录的患者中，以 40-80mg/min 的速度输注。17 例患者在使用 LCM 后 SE 停止，而 22 例患者需要进一步的抗惊厥治疗。在接受 LCM 作为一线或二线药物的患者中，成功率为 3/5，作为三线药物的成功率为 11/19，作为四线或更后线药物的成功率为 3/15。在 5 名患者中，SE 根本无法终止。没有记录到与 LCM 相关的严重不良事件。
静脉用 LCM 可能是标准治疗失败后或当标准药物被认为不适合时治疗已确立 SE 的一种替代治疗方法。
