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The fourth secondary antiepileptic drug I keep in my backpocket is Vimpat or lacosamide. This medication works by enhancing slow inactivation of sodium channels. Indicated for partial-onset seizure, there have been off-label use in refractory SE. Limited studies associate Vimpat with a similiar incidence of seizure termination. You can give it as IV, titrate to effect into oral, and no monitoring. Caution in prolonged PR intervals, check a baseline EKG and again at steady state. For more PHARMFA
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