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Research Snapshot Theater: Pharmacology/Neuroscience, Adult

Evaluation of Lacosamide as Third-Line Therapy for Refractory Status Epilepticus

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 08
Introduction: Status epilepticus (SE) is a life-threatening condition that requires timely administration of anti-seizure medications to achieve seizure cessation and prevent long-term sequalae. Refractory SE (RSE), defined as patient experiencing clinical or electrographic seizures after receiving adequate first- and second-line therapy, is associated with increased morbidity and mortality. If first- and second-line therapy fails, the American Epilepsy Society guidelines state there is no clear evidence to guide third line therapy selection. The purpose of this study is to evaluate the safety and efficacy of lacosamide as a third line agent in RSE.


Methods: This single center, retrospective cohort study included patients admitted with RSE from January 2020 to March 2025. The primary outcome was incidence of seizure cessation with lacosamide compared to other third line therapy. Secondary outcomes included the use of sedatives infusions in patients who received lacosamide at any point in therapy versus other third line agents and incidence of adverse effects, including heart block and, hypotension requiring vasopressors. Fisher’s exact test was used for categorical variables.


Results: Forty-four patients were included, of whom sixteen received lacosamide. Ten patients received third line lacosamide. Seizure cessation following lacosamide third line occurred in 4/10 (40%) patients compared to 19/34 (55%) patients who received other third line agents (p=0.48). Sedatives infusions were required in 4/10 (40%) lacosamide treated patients, and 10/34 (29.4%) in non-lacosamide treated patients (p>0.99). Heart block or bradycardia occurred in one patient from each group (p>0.99). Hypotension requiring vasopressors occurred in 5/16 (31.3%) patients who received lacosamide compared to 6/25 (24%) (p=0.4716). Multi-variate logistic regression including time to treatment, seizure history, admission Glasgow coma scale, adequacy of first- and second-line treatment, and third line drug choice did not identify any factors associated with third line cessation.


Conclusions: Rate of seizure cessation with lacosamide was not statistically different compared to other established third line agents for refractory status epilepticus prior to use of continuous infusion sedatives. Further data are needed to support these findings.