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IV Levetiracetam versus IV Phenytoin in Childhood Seizures: A Randomized Controlled Trial
Kanika Singh1, Anju Aggarwal1, M M A Faridi1
1Department of Paediatrics, University College of Medical Sciences and GTB Hospital, Delhi - 110095 India.
Insights
Intravenous levetiracetam and phenytoin demonstrate comparable efficacy in preventing recurrent acute seizures in children within 24 hours. Both treatments are effective for pediatric seizure management.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Acute seizures in children require prompt and effective treatment.
- Intravenous (IV) phenytoin and IV levetiracetam are commonly used antiepileptic drugs.
Purpose of the Study:
- To compare the efficacy and safety of IV phenytoin versus IV levetiracetam in pediatric patients experiencing acute seizures.
Main Methods:
- A randomized controlled trial was conducted with 100 children (aged 3-12 years) presenting with acute seizures.
- Participants received either IV phenytoin (20 mg/kg) or IV levetiracetam (30 mg/kg), with diazepam administered prior to these drugs if seizures persisted.
- Outcomes included seizure absence within 24 hours, seizure cessation within 20 minutes, cardiorespiratory changes, and therapeutic drug levels.
Main Results:
- Efficacy was comparable, with 94% of levetiracetam patients and 96% of phenytoin patients remaining seizure-free for 24 hours (P > 0.05).
- Levetiracetam showed a trend towards faster seizure cessation and less sedation.
- Therapeutic drug levels were achieved more consistently and rapidly with levetiracetam compared to phenytoin.
Conclusions:
- IV levetiracetam and IV phenytoin exhibit similar efficacy in preventing 24-hour seizure recurrence in children with acute seizures.
- Levetiracetam may offer advantages in terms of faster onset and potentially fewer side effects like sedation.
Objectives:
To compare the efficacy of IV phenytoin and IV levetiracetam in acute seizures.
Design:
Randomized controlled trial.
Setting:
Tertiary care hospital, November 2012 to April 2014.
Patients:
100 children aged 3-12 yrs of age presenting with acute seizures.
Intervention:
Participants randomly received either IV phenytoin 20 mg/kg (n = 50) or IV levetiracetam 30 mg/kg (n = 50). Patients who were had seizures at presentation received IV diazepam prior to these drugs.
Outcome Measures:
Primary: Absence of seizure activity within next 24 hrs.Secondary: Stopping of clinical seizure activity within 20 mins of first intervention, change in cardiorespiratory parameters, and achievement of therapeutic drug levels.
Results:
Two groups were comparable in patient characteristics and seizure type (P > 0.05). Of the 100 children, 3 in levetiracetam and 2 in phenytoin group had a repeat seizure in 24 hrs, efficacy was comparable (94% vs 96%, P > 0.05). Of these, 18 (36%) in phenytoin and 12 (24%) in levetiracetam group received diazepam. Sedation time was 178.80 ±97.534 mins in phenytoin and 145.50 ±105.208 mins in levetiracetam group (P = 0.346). Changes in cardiorespiratory parameters were similar in both groups except a lower diastolic blood pressure with phenytoin (P = 0.023). Therapeutic drug levels were achieved in 38 (76%) children both at 4 and 24 hrs with phenytoin, compared to 50 (100%) and 48 (98%) at 1 and 24 hrs with levetiracetam (P < 0.05).
Conclusion:
Intravenous levetiracetam and phenytoin have similar efficacy in preventing seizure recurrences for 24 hrs in children 3-12 years presenting with acute seizures.
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