Title |
Randomized trial of lacosamide versus fosphenytoin for nonconvulsive seizures
|
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Published in |
Annals of Neurology, July 2018
|
DOI | 10.1002/ana.25249 |
Pubmed ID | |
Authors |
Aatif M. Husain, Jong W. Lee, Bradley J. Kolls, Lawrence J. Hirsch, Jonathan J. Halford, Puneet K. Gupta, Yafa Minazad, Jennifer M. Jones, Suzette M. LaRoche, Susan T. Herman, Christa B. Swisher, Saurabh R. Sinha, Adriana Palade, Keith E. Dombrowski, William B. Gallentine, Cecil D. Hahn, Elizabeth E. Gerard, Manjushri Bhapkar, Yuliya Lokhnygina, M. Brandon Westover, for the Critical Care EEG Monitoring Research Consortium |
Abstract |
The optimal treatment of nonconvulsive seizures in critically ill patients is uncertain. We evaluated the comparative effectiveness of antiseizure drugs (ASD) lacosamide (LCM) and fosphenytoin (fPHT) in this population. The Treatment of Recurrent Electrographic Nonconvulsive Seizures (TRENdS) study was a non-inferiority, prospective, multicenter, randomized treatment trial of patients diagnosed with NCS by continuous electroencephalography (cEEG). Treatment was randomized to IV LCM 400 mg or IV fPHT 20 mg PE/kg. The primary endpoint was absence of electrographic seizures for 24 hours as determined by one blinded EEG reviewer. The frequency with which NCS control was achieved in each arm was compared, and the 90% confidence interval (CI) was determined. Non-inferiority of LCM to fPHT was to be concluded if the lower bound of the CI for relative risk was above 0.8. Seventy-four subjects were enrolled (37 LCM, 37 fPHT) between August 21, 2012 and December 20, 2013. The mean age was 63.6 years; 38 were women. Seizures were controlled in 19 of 30 (63.3%) subjects in the LCM arm and 16 of 32 (50%) subjects in the fPHT arm. LCM was non-inferior to fPHT (p = 0.02), with a risk ratio of 1.27 (90% CI=0.88, 1.83). Treatment emergent adverse events (TEAE) were similar in both arms, occurring in 9/35 (25.7%) of LCM and 9/37 (24.3%) of fPHT subjects (p=1.0). LCM was non-inferior to fPHT in controlling NCS, and TEAE were comparable. LCM can be considered an alternative to fPHT in the treatment of NCS detected on cEEG. This article is protected by copyright. All rights reserved. |
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Venezuela, Bolivarian Republic of | 1 | 3% |
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Scientists | 4 | 12% |
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Science communicators (journalists, bloggers, editors) | 1 | 3% |
Mendeley readers
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Unknown | 92 | 100% |
Demographic breakdown
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Other | 11 | 12% |
Professor > Associate Professor | 9 | 10% |
Student > Bachelor | 9 | 10% |
Student > Doctoral Student | 8 | 9% |
Other | 23 | 25% |
Unknown | 19 | 21% |
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Other | 4 | 4% |
Unknown | 28 | 30% |