Oral Lacosamide as treatment option in a case of aphasic status epilepticus with continuous spike-and-wave discharges of the adult

We present a case report of a 58 year-old man who suffered from simptomatic focal epilepsy due to artero-venous malformation localized in the left superior temporal gyrus. After the excision of the lesion he developed drugresistant epilepsy with temporal seizures characterized by behavioral arrest, automatisms, and aphasia. Despite numerous attempts with different AEDs (CBZ, PHT, LEV) the patient presented monthly seizures. He was admitted to our Department for non-convulsive status epilepticus, clinically characterized by aphasia and confusion, associated to continuous spikes and wave discharges over the fronto-temporal derivations of the left hemisphere. CBL and VPA were added to his therapy, while LEV was suspended for marked irritability. His language disturbance continued to be severe and he underwent neuropsychological evaluation and language fMRI, which documented complex language disorder. Only after gradually introducing oral Lacosamide the patient improved significantly. At 6 months follow-up he no longer experienced recurrent seizures, his EEG was free from epileptiform abnormalities and the aphasia was partially improved, too. We suggest that oral Lacosamide can be a therapeutic option for non convulsive status epilepticus.