Levetiracetam versus phenytoin in children with Status epilepticus

PubMed Central: Published on October 2019

Status epilepticus is most common in children younger than 5 years, with incidence between 10 and 60 per 100,000 populations.

Convulsive status for 30 min leads to irreversible neuronal injury.

TAKE HOME MESSAGE

Established Status Epilepticus Treatment Trial proposed that 35%–45% of patients with convulsive status epilepticus did not respond to benzidizapine; levetiracetam can be given in them.

There are retrospective studies on the use of intravenous (IV) levetiracetam in acute seizures in children, in view of paucity of studies of levetiracetam and its comparison with phenytoin in status epilepticus in children.

This study was done to compare the efficacy and safety of intravenous levetiracetam and phenytoin in status epilepticus.

In this study, the most common type of seizure was generalized type followed by simple partial seizure followed by complex partial seizure.

Authors observed that seizure control for 24 h was significantly better in the levetiracetam group when compared with the phenytoin group.

In the study, 75% of patients achieved seizure control after initial loading dose (40 mg/kg) of levetiracetam and the remaining 25% needed an additional minibolus (10 mg/kg) to achieve seizure control. After seizure control, we used a maintenance dose of 20 mg/kg/day at 12 hourly intervals.

In this study, 2 (3.8%) patients in the levetiracetam group and 18 (34.6%) in the phenytoin group had seizure recurrence within 1–24 h.

Conclusion:

Levetiracetam was found to have no significant side effects on cardiorespiratory parameters as reported in previous studies. In our study also there were no significant adverse effects in either of the group which was similar to other studies.

Hence, to conclude, levetiracetam was found to be more efficacious when compared with phenytoin in controlling seizures with no side effects and it can be used as an alternative second-line antiepileptic drug in children with status epilepticus.

Available Brand

Doctors Liked to Read More

Abstract

Background:

To compare the efficacy and safety of intravenous levetiracetam and phenytoin in status epilepticus.

Methodology:

A prospective, randomized controlled, nonblinded study was conducted in children 1 month to 12 years of age with active seizure and with status epilepticus. A total of 104 children were randomly allocated to either group 1 (levetiracetam) or group 2 (phenytoin) on the basis of computer-generated random number table. Children already on antiepileptic drugs, very sick children with shock, impending respiratory failure, or head injury, and children hypersensitive to phenytoin or levetiracetam were excluded. Data analysis was done by IBM SPSS statistics.

Results:

The mean age was 4.09 years with a male preponderance with the most common type of seizure being generalized type (74%). The seizures were controlled in all 104 patients initially within 40 min. Seizure control for 24 h was significantly better in group 1 (96%) when compared with group 2 (59.6%). Minibolus of drug was given in 28.8% in group 1 and 46.2% in group 2. The seizure recurrence in groups 1 and 2 in the first hour was 1.9% and 5.8%, respectively, whereas the recurrence between 1 and 24 h was significantly more in group 1 (34.6%) when compared with group 2 (3.8%). The mean time to control seizure was comparable between both the groups. There was no significant adverse effect in both the groups.

Conclusion:

Levetiracetam is more effective than phenytoin for seizure control for 24 h in children with status epilepticus, and it is safe and effective as a second-line therapy.

Rate This Article