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NCS Currents Sept 2016

NEUROCRITICAL CARE PHARMACY Drug FDA approved indication (s) Pharmacology Dosing Inclusion in guidelines for treatment of SE Y/N? Evidence for use in SE Y/N? Type of evidence Description of evidence Brivaracetam (Briviact®) Adjunctive therapy in the treatment of partial-onset seizures SV2A ligand with greater affinity than levetiracetam for this target 25, 50, or 100 mg IV/ PO twice daily (25 mg dosing is advised in hepatic failure) N N NA NA Clobazam (Onfi©) Adjunctive treatment of Lennox-Gastaut Syndrome Enhances inhibitory effect of GABA-A receptors 5, 10, 20 mg PO twice daily N Y Case series In two published case series in Europe and U.S., resolution of SE was reported in 96% and 76% of patients respectively. Eslicarbazepine (Aptiom©) Monotherapy or adjunct therapy of partial-onset seizures Involves inhibition of voltage-gated sodium channels 400-1600 mg PO daily N N NA NA Ezogabine (Potiga©) Adjunctive treatment of partialonset seizures in adults who failed alternative treatments and for whom the benefits outweigh the risk of visual loss Binds the KCNQ voltage-gated potassium channels 600 to 1200 mg PO daily N N NA NA Lacosamide (Vimpat©) Monotherapy or adjunctive therapy in patients with partial-onset seizures Enhances slow sodium channels 100-200 mg IV/PO twice daily Y (Class IIb, level C) Y Case reports/ case series Seven cases of successful use of lacosamide as add-on therapy in adults with refractory SE were reported in 2011. In a case series of European centers, 17 (43%) patients responded to lacosamide. In a case series of 39 patients with SE, 25 (81%) patients responded to lacosamide. Perampanel (Fycompa©) Adjunctive treatment of partialonset seizures and primary generalized tonic-clonic seizures Blocks (AMPA) receptor selectively and non-competitively 4–12 mg PO daily N Y Retrospective chart review of 12 patients in a Neuro ICU showed clinical improvement in two (17%) patients with SE. Rufinamide (Banzel©) Adjunctive treatment of seizures associated with Lennox- Gastaut Syndrome Modulates the activity of sodium channels 400 to 3200 mg PO in two divided doses/day N Y Case report One successful case report in SE after initiation of firstline agents. Vigabatrin (Sabril©) Adjunctive treatment of refractory complex partial seizures and infantile spasms Inhibits of GABA transaminase irreversibly N N NA NA 23


NCS Currents Sept 2016
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