Intravenous levetiracetam vs phenytoin for status epilepticus and cluster seizures: A prospective, randomized study

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Abstract

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.

Original languageEnglish
Pages (from-to)8-12
Number of pages5
JournalSeizure
Volume49
DOIs
Publication statusPublished - Jul 1 2017

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etiracetam
Status Epilepticus
Phenytoin
Seizures
Prospective Studies
Emergencies
Logistic Models

Keywords

  • Anticonvulsant treatment
  • Cluster Seizures
  • Levetiracetam
  • Phenytoin
  • Status Epilepticus

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

@article{3d28d9120479488aab7f1ddead5b9a6e,
title = "Intravenous levetiracetam vs phenytoin for status epilepticus and cluster seizures: A prospective, randomized study",
abstract = "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.",
keywords = "Anticonvulsant treatment, Cluster Seizures, Levetiracetam, Phenytoin, Status Epilepticus",
author = "Gujjar, {Arunodaya R.} and Ramachandiran Nandhagopal and Jacob, {Poovathoor C.} and Abdulhakeem Al-Hashim and Khalfan Al-Amrani and Ganguly, {Shyam S.} and Abdullah Al-Asmi",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.seizure.2017.05.001",
language = "English",
volume = "49",
pages = "8--12",
journal = "Seizure : the journal of the British Epilepsy Association",
issn = "1059-1311",
publisher = "W.B. Saunders Ltd",

}

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

PY - 2017/7/1

Y1 - 2017/7/1

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

VL - 49

SP - 8

EP - 12

JO - Seizure : the journal of the British Epilepsy Association

JF - Seizure : the journal of the British Epilepsy Association

SN - 1059-1311

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