Optimizing Levetiracetam Dosage in Status Epilepticus: A Retrospective Cohort Study

Status epilepticus (SE) is a severe neurological condition with significant morbidity and mortality. While guidelines offer recommendations for emergent therapy with benzodiazepines, there is limited guidance for medications for urgent control in SE. High-dose levetiracetam (LEV) (60 mg/kg) was introduced in the 2019 ESETT trial and has not been studied against the previous standard.

This retrospective cohort evaluated patients admitted for SE. Patients were included if they received ≥1 dose of intravenous LEV ≥20 mg/kg from January 1, 2019, to January 14, 2022, and were 17 years of age or older. Traumatic injuries were excluded. Patients were divided into groups of LEV loading dose of <40 mg/kg and LEV loading dose of ≥40 mg/kg.

Patients who received ≥40 mg/kg of LEV were less likely to require a second ASM within 48 hours as compared with those receiving <40 mg/kg [39(69.9%) vs. 15(38.5%); P =0.0127]. After logistic regression analysis that included home ASM use, doses ≥40 mg/kg of LEV, and a total of ≥4 mg of lorazepam equivalents received, no difference was seen in ASM requirements. Patients who received <40 mg/kg were more likely to have a history of seizure and be on ASMs before admission.

After logistic regression, the loading dose of LEV did not change the need for additional ASM to control seizures in SE. Further investigations evaluating the efficacy of 20 mg/kg compared with 60 mg/kg are needed; however, this study found no difference in seizure control between the groups.