TY - JOUR
T1 - Intravenous levetiracetam vs phenytoin for status epilepticus and cluster seizures
T2 - A prospective, randomized study
AU - Gujjar, Arunodaya R.
AU - Nandhagopal, Ramachandiran
AU - Jacob, Poovathoor C.
AU - Al-Hashim, Abdulhakeem
AU - Al-Amrani, Khalfan
AU - Ganguly, Shyam S.
AU - Al-Asmi, Abdullah
N1 - Publisher Copyright:
© 2017 British Epilepsy Association
PY - 2017/7
Y1 - 2017/7
N2 - Purpose Status Epilepticus (SE) is a common medical emergency carrying a high morbidity and mortality. Levetiracetam (LEV) is a novel anticonvulsant effective against varied seizures. Few prospective studies have addressed its use in SE. We aimed to examine the efficacy of intravenous LEV in controlling SE and cluster attacks of seizures (CS), in comparison with IV phenytoin (DPH), using a prospective, randomized study design. Method Adult patients with SE or CS, following an initial dose of IV benzodiazepine to control ongoing seizure, were randomized to receive either medication. Rates of seizure control over 24 h, adverse effects and outcomes were compared. A logistic regression model was used to identify outcome predictors. Results 52 patients with SE and 63 with CS received either LEV or DPH. In the SE group, LEV was effective in18/22(82%) and DPH in 22/30(73.3%) patients in controlling seizures. Among patients with CS, LEV was effective in 31/38(81.6%) and DPH in 20/25(80%). With the use of LEV, DPH or both, SE and CS were controlled among 92% and 96% of patients respectively. Adverse events included hypotension (in 2 on DPH) and transient agitation (2 on LEV). Conclusions IV Levetiracetam controls status epilepticus or cluster seizures with an efficacy comparable to that of phenytoin. Use of these two agents consecutively may control >90% of all such conditions without resort to anaesthetic agents. Further studies should explore its efficacy in larger cohorts of epileptic emergencies.
AB - Purpose Status Epilepticus (SE) is a common medical emergency carrying a high morbidity and mortality. Levetiracetam (LEV) is a novel anticonvulsant effective against varied seizures. Few prospective studies have addressed its use in SE. We aimed to examine the efficacy of intravenous LEV in controlling SE and cluster attacks of seizures (CS), in comparison with IV phenytoin (DPH), using a prospective, randomized study design. Method Adult patients with SE or CS, following an initial dose of IV benzodiazepine to control ongoing seizure, were randomized to receive either medication. Rates of seizure control over 24 h, adverse effects and outcomes were compared. A logistic regression model was used to identify outcome predictors. Results 52 patients with SE and 63 with CS received either LEV or DPH. In the SE group, LEV was effective in18/22(82%) and DPH in 22/30(73.3%) patients in controlling seizures. Among patients with CS, LEV was effective in 31/38(81.6%) and DPH in 20/25(80%). With the use of LEV, DPH or both, SE and CS were controlled among 92% and 96% of patients respectively. Adverse events included hypotension (in 2 on DPH) and transient agitation (2 on LEV). Conclusions IV Levetiracetam controls status epilepticus or cluster seizures with an efficacy comparable to that of phenytoin. Use of these two agents consecutively may control >90% of all such conditions without resort to anaesthetic agents. Further studies should explore its efficacy in larger cohorts of epileptic emergencies.
KW - Anticonvulsant treatment
KW - Cluster Seizures
KW - Levetiracetam
KW - Phenytoin
KW - Status Epilepticus
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U2 - 10.1016/j.seizure.2017.05.001
DO - 10.1016/j.seizure.2017.05.001
M3 - Article
C2 - 28528211
AN - SCOPUS:85019576182
SN - 1059-1311
VL - 49
SP - 8
EP - 12
JO - Seizure
JF - Seizure
ER -