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Levetiracetam for convulsive status epilepticus in childhood: systematic review and meta-analysis

Ibtihal Abdelgadir^1,2, Ali Hamud¹, Ayodeji Kadri¹

¹Department of Emergency Medicine, Sidra Medicine, Doha, Qatar.

Archives of Disease in Childhood

|October 16, 2020

Insights

Levetiracetam is a safe and effective second-line treatment for childhood convulsive status epilepticus (CSE). It shows comparable efficacy and safety to other standard treatments like phenytoin and valproate in pediatric patients.

Area of Science:

Pediatric Neurology
Emergency Medicine
Clinical Pharmacology

Background:

Prolonged seizures, or convulsive status epilepticus (CSE), represent a critical pediatric emergency with substantial morbidity.
Effective and safe pharmacological interventions are crucial for managing CSE in children.

Purpose of the Study:

To systematically evaluate the efficacy and safety of levetiracetam as a second-line treatment for childhood CSE.
To compare levetiracetam with established anti-epileptic drugs in pediatric CSE management.

Main Methods:

A comprehensive literature search was conducted across major databases (PubMed, Embase, Cochrane, CINAHL) up to April 2020.
Only randomized controlled trials (RCTs) involving children aged 1 month to 18 years were included, with data extracted by two independent reviewers.
Ten RCTs, comprising 1907 participants, met the inclusion criteria for analysis.

Main Results:

Levetiracetam demonstrated comparable efficacy to phenytoin, fosphenytoin, and valproate in achieving seizure cessation.
No significant differences were observed in the time to seizure cessation, intensive care unit (ICU) admissions, or need for rapid sequence intubation (RSI).
Adverse events, seizure recurrence at 24 hours, and all-cause mortality rates were similar across treatment groups.

Conclusions:

Levetiracetam is a viable and comparable second-line therapeutic option for pediatric convulsive status epilepticus.
The findings support the use of levetiracetam as an alternative to phenytoin, fosphenytoin, and valproate in this critical pediatric condition.

Read full analysis

Abstract

Importance:

Prolonged seizures are life-threatening emergencies associated with significant morbidity.

Objective:

To determine the efficacy and safety of levetiracetam in treating convulsive status epilepticus (CSE) in childhood.

Data Sources And Study Selections:

PubMed, Embase, the Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature were searched from inception up to April 2020. Only randomised controlled trials (RCTs) that included children aged 1 month-18 years were assessed. Two reviewers performed data assessment and extraction.

Data Extraction And Synthesis:

Ten studies out of the 20 637 citations identified were included.

Main Outcomes:

Cessation of seizure activities, time to cessation of seizure activities, need for rapid sequence intubation (RSI), intensive care unit (ICU) admission, recurrence of seizures at 24 hours, adverse events and all-cause mortality.

Results:

We included 10 RCTs (n=1907). There was no significant difference in cessation of seizure activities when levetiracetam was compared with phenytoin (risk ratio (RR)=1.03, 95% CI 0.98 to 1.09), levetiracetam to fosphenytoin (RR=1.16, 95% CI 1.00 to 1.35) or levetiracetam to valproate (RR=1.10, 95% CI 0.94 to 1.27). No differences were found in relation to the timing of cessation of seizures for levetiracetam versus phenytoin (mean difference (MD)=-0.45, 95% CI -1.83 to 0.93), or levetiracetam versus fosphenytoin (MD=-0.70, 95% CI -4.26 to 2.86). There were no significant differences with regard to ICU admissions, adverse events, recurrence of seizure at 24 hours, RSI and all-cause mortality.

Conclusion:

Levetiracetam is comparable to phenytoin, fosphenytoin and valproate as a second line treatment of paediatric CSE.

Keywords:

neurology pharmacology therapeutics

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