Efficacia della lacosamide nello stato epilettico focale motorio: Studio clinico e video-poligrafico

Purpose: In vitro and in in vivo studies have shown a possible efficacy of LCM in the treatment of motor seizures and status epilepticus. We evaluate efficacy and tolerability of intravenous LCM in the treatment of refractory focal motor status epilepticus after failure of conventional therapy. Method: Patients presented with refractory focal motor status epilepticus underwent LCM i.v. therapy and a long-term video-EEG/polygraphic monitoring before and after LCM treatment. Results: Three patients (2 female, 1 male), aged between 60 and 70, with symptomatic (gliomatosis cerebri, brain metastasis of lung adenocarcinoma, ischemic stroke) focal motor status epilepticus were investigated. The first patient showed left fronto-central polyspikeand-wave activities associated with tonic contraction of right orbicularis oris followed by tonic-clonic activity in the right masseter and orbicularis oris, hypersalivation and aphasia. The second one presented with aphasia and tonic-clonic activity of right extensor hand muscles associated with left fronto-temporal epileptic discharge. The third one had repetitive left leg tonic-clonic activity with epileptic discharge over the vertex and right anterior region. In all patients we recorded a progressive reduction of seizure duration and intensity and the clinical and polygraphic disappearance of the focal motor status within 24 hours since the first administration of 400 mg of LCM i.v., after an ineffective treatment with DZP (10 mg i.v.) and LEV (3000 mg i.v.). All patients had no seizures recurrence with a maintaining dose of 400 mg/day. Conclusion: The clinical and polygraphic features of three patients with refractory focal motor status epilepticus suggest that LCM i.v. may be effective in the treatment of focal motor status epilepticus, but larger studies need to confirm the efficacy.