Optimizing Levetiracetam Dosage in Status Epilepticus: A Retrospective Cohort Study

Area of Science:

• Neurology
• Pharmacology

Background:

• Status epilepticus (SE) is a critical neurological emergency with high morbidity and mortality.
• Current guidelines focus on emergent benzodiazepine therapy, with limited evidence for urgent control medications.
• High-dose levetiracetam (LEV) (60 mg/kg) was proposed in the ESETT trial, but its efficacy compared to previous standards requires further study.

Purpose of the Study:

• To evaluate the impact of different intravenous levetiracetam (LEV) loading doses on seizure control in adult patients with status epilepticus (SE).
• To compare the need for additional anti-seizure medications (ASMs) within 48 hours based on LEV loading dose (<40 mg/kg vs. ≥40 mg/kg).

Main Methods:

• Retrospective cohort study of adult patients admitted for SE between January 1, 2019, and January 14, 2022.
• Patients received intravenous LEV ≥20 mg/kg; traumatic injuries were excluded.
• Groups were defined by LEV loading dose: <40 mg/kg and ≥40 mg/kg.

Main Results:

• Initially, patients receiving ≥40 mg/kg LEV were less likely to require a second ASM within 48 hours (38.5%) compared to those receiving <40 mg/kg (69.9%), P=0.0127.
• After logistic regression, adjusting for home ASM use and lorazepam equivalents, no significant difference in ASM requirements was observed between the LEV dose groups.
• Patients receiving <40 mg/kg LEV were more likely to have a history of seizures and be on ASMs prior to admission.

Conclusions:

• The loading dose of LEV did not significantly alter the need for additional ASMs to achieve seizure control in SE after logistic regression analysis.
• This study found no difference in seizure control between LEV loading doses of <40 mg/kg and ≥40 mg/kg.
• Further research comparing 20 mg/kg versus 60 mg/kg LEV is warranted to establish optimal dosing strategies for SE.