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Efficacy Of Levetiracetam Versus Phenytoin As A Second-Line Antiepileptic Drug In The Management Of
Babar Naeem1, Mommna Ashfaq1, Mamoon Akbar Qureshi1
1Paediatrics Department, Jinnah Hospital Lahore, Pakistan.
Insights
Levetiracetam is a more effective and safer second-line treatment for pediatric status epilepticus than phenytoin. This study found levetiracetam achieved higher seizure cessation rates with fewer adverse events.
Area of Science:
- Pediatric Neurology
- Emergency Medicine
- Clinical Pharmacology
Background:
- Status epilepticus (SE) is a critical neurological emergency requiring prompt treatment.
- Current SE management relies on benzodiazepines, but data on subsequent-line treatments in children is limited.
- This study investigated levetiracetam versus phenytoin as a second-line therapy for pediatric SE.
Purpose of the Study:
- To compare the efficacy and safety of levetiracetam and phenytoin as second-line treatments for pediatric status epilepticus.
- To provide evidence-based recommendations for managing refractory SE in children.
Main Methods:
- A randomized trial involving 137 pediatric patients with status epilepticus.
- Group I received intravenous levetiracetam (LEV), Group II received intravenous phenytoin (PHT).
- Primary outcome was seizure cessation within 30 minutes; secondary outcomes included need for additional anticonvulsants and adverse events.
Main Results:
- Levetiracetam achieved seizure cessation in 94% of patients, compared to 77% with phenytoin (p=0.046).
- Mean time to seizure termination was shorter with levetiracetam (19.94 min) versus phenytoin (23.79 min).
- Levetiracetam demonstrated a superior safety profile with fewer and less severe adverse events.
Conclusions:
- Levetiracetam is a highly effective and safe second-line antiepileptic drug for pediatric status epilepticus.
- Levetiracetam offers a favorable alternative to phenytoin for refractory SE in children.
- The findings support levetiracetam as a preferred agent when initial benzodiazepine therapy fails.
Background:
Status Epilepticus (SE) is a life-threatening neurological emergency requiring appropriate therapy to terminate seizure activity. SE is managed with supportive measures and ultra-short-acting benzodiazepines. However, limited data is available in the paediatric population regarding the next best option when this fails. This study aimed at finding new data to recommend levetiracetam or phenytoin as the second-line option.
Methods:
One hundred and thirty-seven patients with status epilepticus were randomized into two groups; group-I was given IV Levetiracetam (LEV) at 20 mg/kg/dose over 5 minutes followed by a maintenance dose of 20mg/kg/dose BID, whereas Group II received phenytoin at 20mg/kg IV loading dose followed by a maintenance dose of 5-8 mg/kg/day divided BID. The primary outcome was seizure cessation, defined as the termination of the apparent convulsion 30 min after the administration of phenytoin or levetiracetam. Secondary outcomes were the use of different anti-convulsants for continued management, admittance to critical treatment, and severe adverse events (including mortality, Stevens-Johnson syndrome, rash, airway problems, cardiovascular instability, extravasation, and severe agitation). Data was recorded via a clinical proforma and was analyzed by SPSS software version 25. All numerical data were expressed in mean±SD forms, and frequency was determined for qualitative baseline data. Secondary outcomes were tested through the χ2 test, A p-value of ≤0.05 was considered statistical significance.
Results:
Levetiracetam terminated seizures in 94% of children compared to 77% in those treated with phenytoin. The mean time to seizure termination was 19.94±3.76 minutes for the LEV Group as compared to 23.791±9.1 min for the PHT group. (p=0.046). Regarding safety, a profile study shows LEV has fewer and less severe side effects compared to Phenytoin.
Conclusions:
Levetiracetam is a safe, well-tolerated, and effective treatment as a second-line antiepileptic drug in the management of status epilepticus.
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