Pyridoxine deficiency in adult patients with status epilepticus.

An 8-year-old girl treated at our facility for superrefractory status epilepticus was found to have a low pyridoxine level at 5 µg/L. After starting pyridoxine supplementation, improvement in the EEG for a 24-hour period was seen. We decided to look at the pyridoxine levels in adult patients admitted with status epilepticus. We reviewed the records on patients admitted to the neurological ICU for status epilepticus (SE). Eighty-one adult patients were identified with documented pyridoxine levels. For comparison purposes, we looked at pyridoxine levels in outpatients with epilepsy (n=132). Reported normal pyridoxine range is >10 ng/mL. All but six patients admitted for SE had low normal or undetectable pyridoxine levels. A selective pyridoxine deficiency was seen in 94% of patients with status epilepticus (compared to 39.4% in the outpatients) which leads us to believe that there is a relationship between status epilepticus and pyridoxine levels.

Safety & pK of IV loading dose of lacosamide in the ICU.

A restrospective review of patients treated in the ICU for refractory status epilepticus who had received an initial IV loading dose of lacosamide (LCS) was performed. A total of 142 patients were identified. The first 34 patients received 400mg which by weight-based measurement ranged from 2 to 11 mg/kg. Higher mg/kg dosing had been used subsequently with doses up to 13 mg/kg. No patient required reduction in rate or cessation of infusion. Initiation of pressor agents was not needed during the infusion of the loading dose. Postinfusion LCS blood levels were drawn, and dosing of 10-12 mg/kg and higher resulted in blood levels above 15 µg/ml while doses of 2-6 mg/kg resulted in levels below 10 µg/ml. We conclude that a weight-based loading dose of 10-12 mg/kg at an infusion rate of 0.4 mg/kg/min is safe and will produce levels of 15 µg/ml and higher. This article is part of a Special Issue entitled "Status Epilepticus".