Department of Neurology, Emory University School of Medicine, 1365 Clifton Road, NE Clinic A, Atlanta, GA 30322, USA.
Neurocrit Care. 2012 Apr;16(2):294-8. doi: 10.1007/s12028-011-9662-0.
Seizures are common in critically ill patients and can impact morbidity and mortality. Traditional anti-epileptic drugs (AEDs) in this setting are not always effective and are associated with adverse events and drug interactions. Lacosamide (LCM) is a new AED which is available in parental form although few studies have evaluated the safety and efficacy of LCM in critically ill patients.
Critically ill patients at Emory University Hospital who received LCM from April 1, 2009 to February 1, 2010 were retrospectively reviewed. Primary outcome measure was incidence and time to seizure cessation. Adverse effects were also recorded.
LCM was administered in 24 patients including 13 episodes of refractory status epilepticus (RSE) occurring in 10 patients and for treatment of isolated seizures or following resolution of RSE in an additional 14 patients. Seizure cessation was achieved in 5/13 (38%) episodes of RSE (mean 11.2 h) while there was at least a 50% decrease in seizure frequency in 7/13 (54%). 11/14 patients (76%) who received LCM for treatment of isolated seizures or prevention of seizure recurrence remained seizure free. Three patients experienced a decline in systolic blood pressure (> 20 mmHg) while one patient experienced unexplained fever and one patient had elevation of liver function tests.
This preliminary data suggests that LCM may be a safe and effective alternative for treatment of seizures in critically ill patients. Further prospective, randomized controlled trials are needed to confirm these findings and further explore the incidence of adverse effects.
在危重病患者中，癫痫发作很常见，会影响发病率和死亡率。在这种情况下，传统的抗癫痫药物（AEDs）并不总是有效，并且会出现不良反应和药物相互作用。拉考沙胺（LCM）是一种新的 AED，可提供注射剂型，尽管很少有研究评估 LCM 在危重病患者中的安全性和疗效。
我们回顾了 2009 年 4 月 1 日至 2010 年 2 月 1 日期间在埃默里大学医院接受 LCM 治疗的危重病患者。主要结局指标是癫痫发作停止的发生率和时间。还记录了不良反应。
共 24 例患者使用了 LCM，包括 10 例患者的 13 例难治性癫痫持续状态（RSE）发作和另外 14 例用于治疗孤立性发作或 RSE 缓解后的发作。13 例 RSE 发作中有 5/13（38%）发作达到癫痫发作停止（平均 11.2 小时），而 13 例中有 7/13（54%）的发作频率至少减少了 50%。14 例接受 LCM 治疗孤立性发作或预防发作复发的患者中有 11/14（76%）例无发作。3 例患者出现收缩压下降（>20mmHg），1 例患者出现不明原因发热，1 例患者出现肝功能检查升高。
这些初步数据表明，LCM 可能是治疗危重病患者癫痫发作的一种安全有效的替代药物。需要进一步的前瞻性、随机对照试验来证实这些发现，并进一步探讨不良反应的发生率。
