Levetiracetam versus phenytoin in children with status epilepticus

Abstract

Background:To compare the efficacy and safety of intravenous levetiracetam and phenytoin in status epilepticus.Methodology:A prospective, randomized controlled, nonblinded study was conducted in children 1 month to 12 years of age with active seizure and with status epilepticus. A total of 104 children were randomly allocated to either group 1 (levetiracetam) or group 2 (phenytoin) on the basis of computer-generated random number table. Children already on antiepileptic drugs, very sick children with shock, impending respiratory failure, or head injury, and children hypersensitive to phenytoin or levetiracetam were excluded. Data analysis was done by IBM SPSS statistics.Results:The mean age was 4.09 years with a male preponderance with the most common type of seizure being generalized type (74%). The seizures were controlled in all 104 patients initially within 40 min. Seizure control for 24 h was significantly better in group 1 (96%) when compared with group 2 (59.6%) (P = 0.0001). Minibolus of drug was given in 28.8% in group 1 and 46.2% in group 2 (P = 0.068). The seizure recurrence in groups 1 and 2 in the first hour was 1.9% and 5.8%, respectively (P = 0.61), whereas the recurrence between 1 and 24 h was significantly more in group 1 (34.6%) when compared with group 2 (3.8%) (P = 0.0001). The mean time to control seizure was comparable between both the groups (P = 0.71). There was no significant adverse effect in both the groups.Conclusion:Levetiracetam is more effective than phenytoin for seizure control for 24 h in children with status epilepticus, and it is safe and effective as a second-line therapy.

Treating Status Epilepticus: Phenytoin Versus Levetiracetam

“…All patients had established SE. Consistent with previous findings of Wani et al, which was a smaller study, this study showed no significant differences in fosphenytoin, levetiracetam, and valproate efficacies across the age groups [ 19 ]. Also, there was no remarkable difference between fosphenytoin and levetiracetam efficacies in the study subjects [ 20 ].…”

“…In a recent study, Chamberlain et [19]. Also, there was no remarkable difference between fosphenytoin and levetiracetam efficacies in the study subjects [20].…”

“…This study was prospective, randomized controlled, and nonblinded and was carried out with 104 children between one month and 12 years, with the seizure control measured over 24 hours. Interestingly, levetiracetam significantly suppressed seizures compared to phenytoin [ 19 ]. However, the sample size was relatively small, reducing the statistical power of the findings.…”

“…When taken together, these results suggest that levetiracetam is very similar to phenytoin at efficaciously treating SE. Interestingly, Wani et al, Noureen et al, and Besli et al showed that levetiracetam has greater efficacy than phenytoin [ 19 , 23 , 25 ]. However, a recent meta-analysis found no significant difference in efficacy between the two drugs in treating status epilepticus [ 27 ].…”

“…In the hopes of finding a safer alternative to phenytoin, recent studies have compared the efficacy of this AED in treating SE to that of levetiracetam, a relatively newer AED [18][19][20][21][22][23][24][25][26][27][28]. This article provides an overview of the different stages of SE, discusses the use of phenytoin and levetiracetam in treating SE patients, and highlights the key benefits of levetiracetam over phenytoin in treating SE patients.…”