Benzodiazepines are used as first-line treatments for status epilepticus. Fosphenytoin (FPHT) is recommended for second-line therapy; however, intravenous injection of levetiracetam (LEV) may also be effective against status epilepticus. Herein, we compared the efficacy and safety of LEV as a second-line treatment for status epilepticus with FPHT in Japanese patients.Patients with status epilepticus were selected from the database of the Emergency and Critical Care Center of Hitachi General Hospital. The subjects were patients whose status epilepticus was successfully stopped by diazepam, and in whom FPHT or LEV was administered after diazepam. As LEV injections recently became clinically available in Japan, the choice of drug was determined by the treatment period. Thus, 21 patients who were intravenously injected with LEV as a second-line therapy and 42 matched patients (historical controls) who were treated with FPHT (1:2) were selected.The subjects had a mean age of 64.0 ± 2.2 years, and included 48 males and 15 females. The status epilepticus control rates of the FPHT and LEV groups did not differ significantly (81.0% [34/42] vs 85.1% [18/21], respectively; P  =  .69). As for serious adverse events, a reduction in blood pressure was observed in the FPHT group, but not in the LEV group. The oral anticonvulsant switching rates of the 2 groups were similar, but the same-drug switching rates of the FPHT and LEV groups were 8.1% and 77.8%, respectively.The efficacy of intravenous LEV injections after status epilepticus was equivalent to that of FPHT, and the incidence of adverse events was lower in the LEV group. LEV is effective and safe at preventing recurrent seizures after status epilepticus following benzodiazepine treatment.

Muscle volume measurement is important for ICUAW evaluation, which has been done using ultrasound and manual muscle testing. We compared the reliability of CT and other methods for muscle volume measurement. This observational study assessed 7 patients 40 years old or older who had been admitted to our ICU. Based on a prespecified CT protocol, muscle volume was evaluated on admission day and at 10-14 days after admission. Results show that the femoral muscle volume decreased significantly by up to 20%. The ICC between two raters was 0.97. Psoas muscle volume decline did not correlate with the femoral muscle decline. Femoral muscle volume evaluation was reliable and objective. This method is useful to quantify the ICUAW severity. Our pilot study based on CT femoral muscle volume evaluation will facilitate further studies to prevent ICUAW. Results show that CT using femoral muscle volume measurement is a reliable means of ICUAW evaluation.

No abstract