Utilizzo di lacosamide ev: Esperienza in due casi di stato di male epilettico refrattario

The new antiepileptic drug LCM is used as add-on therapy for partial seizures. LCM presents with good tolerability, few side effects, poor interaction with other AEDs and the possibility of intravenous formulation. LCM selectively promotes slow inactivation of voltagedependent sodium channels. We report two cases of successful treatment of SE with LCM. Case 1: a 74 years old woman with convulsive status epilepticus (SEC) unresponsive to DZP, PHT and propofol; underwent intravenous thiopental. Other drugs also (VPA and LEV) failed to affect SE. Seven days after onset of SE, intravenous LCM was introduced (bolus 400mg then 400 b.i.d) with resolution of the SE after three days. Case 2: a 63 years old woman with symptomatic partial epilepsy associated with bi-frontal vascular lesions under 2 AEDs (TPM, and LEV). SEC on previous year was treated with DZP e.v.. Recurrence of SEC was not controlled by intravenous DZP and PHT. Two days after initiation of intravenous LCM (200 mg/day) the resolution of SE was observed within 48 hours. Other reports have reported the effectiveness of LCM in refractory SE. In some of these cases, as in ours, LCM was used because of the the lack of therapeutic alternatives. It would be useful to perform large randomized-controlled studies to evaluate the real efficacy of LCM.