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Absence status induced by lacosamide adjunctive therapy.

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Summary

Lacosamide effectively treated generalized tonic-clonic seizures but induced absence status epilepticus in a patient with juvenile myoclonic epilepsy. Discontinuation resolved the absence seizures, highlighting potential risks.

Keywords:
absence statusantiepileptic medicationsidiopathic generalized epilepsylacosamideseizure aggravation

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Area of Science:

  • Neurology
  • Clinical Neurophysiology

Background:

  • Lacosamide is an established adjunctive therapy for refractory focal epilepsy.
  • Its use is expanding to idiopathic generalized epilepsies, with proven efficacy for generalized tonic-clonic seizures (GTCS).
  • Efficacy for myoclonic and absence seizures remains less characterized.

Observation:

  • A patient with juvenile myoclonic epilepsy and refractory GTCS experienced new-onset confusional episodes with lacosamide treatment.
  • These episodes correlated with prolonged generalized spike-and-wave discharges on EEG.
  • The patient exhibited psychomotor slowing and disorientation during these events.

Findings:

  • Lacosamide controlled the patient's GTCS but precipitated absence status epilepticus.
  • Absence status epilepticus was characterized by prolonged generalized spike-and-wave complexes and cognitive impairment.
  • Treatment with lorazepam broke the absence status, and discontinuing lacosamide prevented recurrence.

Implications:

  • This case highlights a potential adverse effect of lacosamide, specifically the induction of absence status epilepticus.
  • Clinicians should be vigilant for non-convulsive seizures, such as absence status, in patients treated with lacosamide, particularly those with generalized epilepsy syndromes.
  • Careful patient selection and monitoring are crucial when using lacosamide for generalized epilepsies.