Status epilepticus following self-poisoning of lacosamide and lamotrigine: A case report with follow-up of drug serum concentrations

Abstract

Summary A 26-year-old male with a history of atypical left temporal lobe epilepsy was found at home by emergency unit. He ingested 6 g of lacosamide and 8 g of lamotrigine. At emergency unit arrival, the patient was lying in his bathroom. He was agitated and experienced tonic-clonic seizure. Administration of diazepam allowed control of status epilepticus. Then, stable vital sign allowed a quick transfer to emergency department. At arrival, he presented a deep coma (Glasgow Coma Score 3), his pupils were symmetrical and reactive. Tracheal intubation was performed; he was then transferred to intensive care unit. Continuous infusion of propofol and clonazepam were administered allowing clinical and electroencephalographic control of the epileptiform discharge. The infusion was totally stopped after 69 hours allowing rapid awakening and extubation. Monitoring of lacosamide and lamotrigine serum concentrations were carried out over 70 hours. Plasma peak concentrations were reached 10 hours after intake. Peak plasma concentrations were 52.4 mg/L for lamotrigine and 53.9 mg/L for lacosamide. Calculated elimination half-lifes were approximately 34 hours and 15–20 hours for lamotrigine and lacosamide. These results were comparable with those measured in healthy subjects.