Lacosamide intoxication in attempted suicide.

Area of Science:

• Pharmacology
• Clinical Neurology
• Toxicology

Background:

• Lacosamide is an anticonvulsant effective for partial-onset seizures by enhancing sodium channel slow inactivation.
• Adverse events at standard doses (up to 600 mg/day) include CNS effects like dizziness and somnolence.
• Human safety data for very high lacosamide dosages are lacking.

Observation:

• A patient with bitemporal epilepsy attempted suicide by ingesting 12g lacosamide, 56g gabapentin, 2g topiramate, and 2.8g zonisamide.
• The patient presented with coma, recurrent generalized tonic-clonic seizures, aspiration pneumonia, hypotension, and PR interval prolongation.
• Supportive treatment was initiated for the patient.

Findings:

• Despite the massive overdose of lacosamide and other antiepileptic drugs (AEDs), the patient experienced complete physical recovery.
• The clinical course demonstrates that survival without sequelae is possible following extreme lacosamide intoxication.
• This case provides novel human data on the safety limits of lacosamide in overdose scenarios.

Implications:

• This case suggests a higher tolerance to lacosamide in overdose than previously established.
• Findings support the critical role of intensive supportive care in managing severe poly-drug overdoses, including AEDs.
• Further research into the pharmacokinetics and toxicodynamics of extreme lacosamide doses may be warranted.