To analyze the efficacy of IV lacosamide versus levetiracetam as an early therapeutic treatment for Non-Convulsive Status Epilepticus.

Nonconvulsive status epilepticus (NCSE) is a subset of status epilepticus (SE) characterized by behavioral changes or cognitive impairment. Studies investigating lacosamide and levetiracetam for the treatment of NCSE have consistently demonstrated promising efficacy, but the quantity of research has been lacking. We aimed to assess and compare the efficacy of IV lacosamide and levetiracetam when used in early treatment of NCSE utilizing a cohort of patients that is larger than any known single-center study. 

We retrospectively reviewed medical records of patients diagnosed with NCSE at Miami Valley Hospital from 2012-2016 that were treated with IV lacosamide(33 patients) or levetiracetam(66 patients). We compared efficacy of both drugs and the effectiveness of their standard doses: lacosamide(200-400mg IV bolus) and levetiracetam(500mg BID). Statistical analyses were completed by a statistician using SPSS software on de-identified and coded data.

Lacosamide was shown to be more effective(p-value <0.001) using a chi-square test when analyzing the percent of patients whose status was improved after the first administration of levetiracetam versus lacosamide. While levetiracetam showed clinical improvement of patients at the third administration(p-value<0.001). When given at a therapeutic level as a first dose or second dose, lacosamide proved to be more effective(p-value=0.003) for the first dose and second dose(p-value=0.009) using a chi-square test. However, levetiracetam was found to be more effective when given as a third medication(p-value=0.005) with chi-square test and Fisher’s exact test(p=0.034) respectively. 

Overall, lacosamide was more effective than levetiracetam when given as the first medication administered for NCSE. While, levetiracetam was found to be more effective as a third line agent or later. Our study provides evidence for lacosamide to be a future therapeutic option in the treatment of NCSE in comparison to a well-known control, levetiracetam.