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Intravenous levetiracetam versus intravenous phenytoin as second Line treatment in pediatric convulsive status

Mamum Kartek1, Abinaya Kannan2, Varun Anand3

  • 1Department of Pediatrics, TRIHMS, Naharlagun, Arunachal Pradesh, India.

Journal of Family Medicine and Primary Care
|September 4, 2024
PubMed

Insights

Levetiracetam (LEV) and phenytoin (PHT) show comparable efficacy and safety as second-line treatments for pediatric status epilepticus (SE). This study found no significant differences in seizure control or adverse events between the two antiseizure medications.

Area of Science:

  • Pediatric Neurology
  • Clinical Pharmacology

Background:

  • Benzodiazepines (BZDs) are first-line for status epilepticus (SE).
  • Intravenous phenytoin (PHT) is the traditional second-line treatment for BZD-refractory SE, based on limited data.
  • Levetiracetam (LEV) is an alternative second-line agent for SE.

Purpose of the Study:

  • To compare the efficacy and safety of intravenous LEV versus PHT as second-line antiseizure medications (ASMs) in children with SE.
  • To evaluate seizure cessation rates, recurrence, and adverse events.
  • To provide evidence for optimal second-line treatment strategies in pediatric SE.

Main Methods:

  • Prospective, randomized controlled, open-label study in children aged 3 months to 15 years with SE.
  • 41 children were randomized to receive either LEV or PHT as second-line therapy.
  • Exclusion criteria included prior or concurrent use of LEV or PHT for the current SE episode.

Main Results:

  • The most common age group was 12 months to 5 years.
  • Clinical seizure cessation within 5 minutes was achieved in 85% of the LEV group and 90.5% in the PHT group.
  • Seizure recurrence within 24 hours was observed in 35% of the LEV group and 38.1% of the PHT group, with no statistically significant differences between groups for seizure cessation, recurrence, or adverse events.

Conclusions:

  • Intravenous LEV is as effective and safe as PHT for second-line treatment of pediatric SE.
  • LEV offers a comparable alternative to PHT in managing BZD-refractory convulsive SE in children.
  • These findings support the use of LEV as a second-line ASM in pediatric SE.
Abstract

Keywords:
Antiseizure medication (ASM)levetiracetam (LEV)phenytoin (PHT)status epilepticus (SE)

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