What is the relative value of the standard anticonvulsants: Phenytoin and fosphenytoin, phenobarbital, valproate, and levetiracetam?

Management and Early Treatment of Status Epilepticus in Adults and Children

“…In one of these studies, IV lorazepam, IV diazepam + phenytoin, IV phenytoin alone, and IV phenobarbital (PB) alone were compared, and IV lorazepam was found to be superior to phenytoin alone (14). In the other three studies, diphenylhydantoin (DPH) was compared with valproate (VPA), and although VPA was as effective as phenytoin in a meta-analysis of these studies, adverse effects were more common in the DPH group (15). Fosphenytoin may be preferred over phenytoin due to the fact that it can be administered faster, has less arrhythmic and hypotensive adverse effects, and less risk of soft tissue necrosis in cases of extravasation.…”

The SAMUKeppra study in prehospital status epilepticus: lessons for future study

“…In ESE, the efficacy of LEV was reported as 51.7% in one study (23) and 73.2% in another study (21). VPA has been used for the treatment of SE in prospective or retrospective series and two randomized open trials (12). An analysis of these trials reported that 693 adults or children in SE had been safely treated with VPA and with a response rate ranging from 60-83%.…”

“…Intravenous formulations of VPA and LEV, which became available in the last decade, can be safely administered rapidly intravenously (17)(18)(19)(20)(21). Multiple publications reporting the treatment of ESE with LEV or VPA have emerged (12,14,22). An analysis of publications until 2009 reported that 707 patients with various forms of SE had been safely treated with LEV, with a success rate was about 70% (3).…”

“…Several agents are frequently used as secondline therapy, including: fosphenytoin (FOS)/PHT, valproate sodium (VPA), PHB, LEV, and lacosamide (LAC). There is clinical and scientific equipoise in this setting (12)(13)(14)(15)(16). Historically PHT or FOS was the most commonly used for the treatment of Established Status Epilepticus (ESE) because few other anti-epileptic drugs (AEDs) were available in the intravenous formulation.…”

“…However rapid intravenous administration of FOS (or PHT) can lead to hypotension, cardiac arrhythmias and purple glove syndrome if extravasation of PHT occurs. The effectiveness of FOS in terminating ESE has not been established (12). Intravenous formulations of VPA and LEV, which became available in the last decade, can be safely administered rapidly intravenously (17)(18)(19)(20)(21).…”