Abstract Details

Title Low Dose Lacosamide-Induced Atrial Fibrillation: Case Analysis with Literature Review

Topic Epilepsy

Presentation(s) P03 - (-)

Poster/Presentation
Number 135

Objective

Background BACKGROUND: Lacosamide (LCM) is a novel anti-epileptic drug (AED) approved by the FDA for adjunct treatment of partial onset epilepsy with and without secondary generalization. LCM selectively modulates voltage-gated sodium channels. AED selection is related to both efficacy and adverse effect profile.

Design/Methods DESIGN/METHODS: Case analysis with literature review.

Results RESULTS: A 67 year-old woman with a history of complex partial seizures, migraines, and multiple myeloma was admitted for autologous bone marrow transplant. This patient had no known prior cardiac disease. Admission medications included methylprednisolone, clotrimazole, fluconazole, acyclovir, neupogen, ondansetron, pantoprazole, loperamide, calcium phospate, and primidone. Renal and hepatic function as well as serum electrolytes were normal. During her admission, episodes of staring with oral/facial automatisms increased in frequency and duration (multiple events/hour). The patient did not respond to addition of levetiracetam (1500 mg bid) and continuous video-EEG was initiated to characterize her seizure activities and to monitor response to treatment. Multiple epileptic events were recorded within four hours on video-EEG. LCM was initiated with 200 mg intravenous infusion, at the end of which an irregularly irregular rhythm was noted on telemetry. Asymptomatic atrial fibrillation lasted for two hours with spontaneous resolution. Atrial fibrillation onset correlated to the theoretical time of maximum LCM plasma concentration. LCM was discontinued.

Conclusions CONCLUSIONS: Low dose LCM may provoke atrial fibrillation in at risk patients. Neurologists and internists need to be cognizant of this potential adverse effect. Cardiac monitoring may be required with LCM dose rapid titration, especially if given intravenously.

Authors/Disclosures
Arnaldo E. Velez, MD (Orlando Health) PRESENTER	No disclosure on file
	No disclosure on file
Robert J. Fox, MD, FAAN (Cleveland Clinic)	Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AB Science. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biogen. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for BMS. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EMD Serono. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Immunic. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Fox has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Siemens. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria Biologica. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as a Consultant for InnoCare Pharma. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Immunic. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AB Science. Dr. Fox has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for BMS. The institution of Dr. Fox has received research support from National Institutes of Health. The institution of Dr. Fox has received research support from National MS Society. Dr. Fox has received publishing royalties from a publication relating to health care.
Stephen Wong, MD (Atlantic Health System)	No disclosure on file
Ram Mani, MD (Rutgers - Robert Wood Johnson Medical School)	No disclosure on file

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