Phenytoin should not be retired: cost-effectiveness, efficacy, and experience

Status epilepticus (SE) is a common neurological emergency that occurs in children and adults. It can be treated with different antiseizure medications (ASMs). Benzodiazepines represent the first line of treatment. If seizure activity does not cease, it is a common clinical practice to prescribe the patient either phenytoin (PHT), levetiracetam, or valproate. For decades, PHT has remained a cornerstone in the treatment of certain types of seizures, despite the emergence of newer agents such as levetiracetam. The current article explores the ongoing relevance of phenytoin, its unique advantages over levetiracetam in specific contexts, and the importance of individualized treatment in epilepsy management.