Status epilepticus

Feddersen, Berend; Trinka, Eugen

doi:10.1007/s00115-011-3337-0

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…It is a potent antiepileptic with proven efficacy in drug-resistant focal epilepsy 19 and status epilepticus. 7,8,20 It is often preferred over other substances, as it has a favorable side effects profile (less sedating) and a low potential for drug interactions. However, its high osmolarity might seem hazardous when administered subcutaneously.…”

Section: Discussionmentioning

confidence: 99%

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Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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To evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting, we conducted a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, co-administration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions, e.g., irritation or pain at the infusion site. We identified 20 patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings. Most patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. We conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.

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Section: Discussionmentioning

confidence: 99%

“…6 It is effective for a broad range of seizure types and has effectively been used in status epilepticus. 7,8 It has a low potential for drug interactions. Compared with other antiepileptic drugs, it is generally well tolerated and nonsedating.…”

Section: Introductionmentioning

confidence: 99%

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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“…It has been used extensively over the past 50 years in the treatment of SE [ 68 ], but it took almost 20 years to recognize the appropriate doses of phenytoin to be effective in SE [ 69 ]. Due to its slow rate of infusion (maximum 50 mg/min) and its delayed onset of action, it should not be used in early SE [ 30 – 32 , 70 ] The recommended dose is 18–20 mg/kg for adults and 15 mg/kg in the elderly (>65 years). Though phenytoin is not sedative, hypotension (28–50 %) and cardiac arrhythmias (2 %) may complicate the treatment [ 71 , 72 ].…”

Section: Established Status Epilepticus: Stage IImentioning

confidence: 99%

Pharmacotherapy for Status Epilepticus

Trinka

Höfler

Leitinger

et al. 2015

Drugs

178

148

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Status epilepticus (SE) represents the most severe form of epilepsy. It is one of the most common neurologic emergencies, with an incidence of up to 61 per 100,000 per year and an estimated mortality of 20 %. Clinically, tonic-clonic convulsive SE is divided into four subsequent stages: early, established, refractory, and super-refractory. Pharmacotherapy of status epilepticus, especially of its later stages, represents an “evidence-free zone,” due to a lack of high-quality, controlled trials to inform clinical decisions. This comprehensive narrative review focuses on the pharmacotherapy of SE, presented according to the four-staged approach outlined above, and providing pharmacological properties and efficacy/safety data for each antiepileptic drug according to the strength of scientific evidence from the available literature. Data sources included MEDLINE and back-tracking of references in pertinent studies. Intravenous lorazepam or intramuscular midazolam effectively control early SE in approximately 63–73 % of patients. Despite a suboptimal safety profile, intravenous phenytoin or phenobarbital are widely used treatments for established SE; alternatives include valproate, levetiracetam, and lacosamide. Anesthetics are widely used in refractory and super-refractory SE, despite the current lack of trials in this field. Data on alternative treatments in the later stages are limited. Valproate and levetiracetam represent safe and effective alternatives to phenobarbital and phenytoin for treatment of established SE persisting despite first-line treatment with benzodiazepines. To date there are no class I data to support recommendations for most antiepileptic drugs for established, refractory, and super-refractory SE. Limiting the methodologic heterogeneity across studies is required and high-class randomized, controlled trials to inform clinicians about the best treatment in established and refractory status are needed.

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Intensivmedizin bei neurologischen Erkrankungen

Steigerwald

Sitzer

2013

Praxis Der Intensivmedizin

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Status epilepticus

Cited by 5 publications

References 29 publications

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Pharmacotherapy for Status Epilepticus

Intensivmedizin bei neurologischen Erkrankungen

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