To assess changes in the use of antiseizure medications (ASMs) in the management of status epilepticus (SE) between 2019 and 2022, with a particular focus on the increasing role of Lacosamide.

The management of status epilepticus (SE) has traditionally relied on antiseizure medications (ASMs) such as valproic acid, phenytoin and levetiracetam following the administration of benzodiazepines. Recently, lacosamide, which is available in both intravenous (IV) and oral formulations, has gained prominence due to its efficacy and flexibility in treating refractory SE. This study examines shifts in ASM usage over a four-year period, with particular attention to lacosamide’s growing utilization.

A retrospective review was conducted at a single center for patients treated for status epilepticus between 2019 and 2022. Data on antiseizure medication (ASM) use following benzodiazepine administration were collected for the first three lines of treatment. The primary antiseizure medications evaluated were phenytoin (PHT), valproic acid (VPA), levetiracetam (LEV), and lacosamide. The percentage use of each antiseizure medication was compared between 2019 and 2022. Additionally, total antiseizure medication use across all treatment stages was analyzed.

In 2019, levetiracetam was the most common first-line treatment for status epilepticus (64.80%), increasing to 83.64% by 2022. Phenytoin use dropped from 20.00% to 2.73%, while valproic acid decreased from 4.00% to 0.00%. Lacosamide use remained low for first-line treatment but increased as a second-line option from 3.19% in 2019 to 13.64% in 2022, and as a third-line from 2.66% to 4.55%. Overall, lacosamide use across all treatment stages rose from 7.56% to 21.10%, while levetiracetam remained the most used ASM, and phenytoin and valproic acid use declined.

Lacosamide use in status epilepticus management has increased, particularly as a second- and third-line option, reflecting a shift toward newer antiseizure medications. Levetiracetam remains dominant in first-line treatment, while Phenytoin and Valproic acid use has decreased.