Efficacy of levetiracetam versus fosphenytoin for the recurrence of seizures after status epilepticus

Abstract

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.

Levetiracetam vs. Fosphenytoin for Second-Line Treatment of Status Epilepticus: Propensity Score Matching Analysis Using a Nationwide Inpatient Database

“…Levetiracetam, a new AED, binds to the synaptic vesicle protein 2A and regulates the release of neurotransmitters. Earlier observational studies show that levetiracetam is similarly effective and that it is associated with less adverse effects than those of phenytoin (7)(8)(9)(10)(11). Similar findings have been reported from small randomized control studies (12)(13)(14).…”

Fosphenytoin vs. continuous midazolam for pediatric febrile status epilepticus

“…The rate of seizure cessation following treatment with fPHT was 65% in a study of pediatric patients with status epilepticus [8]. The rate of prevention of seizure recurrence following treatment with fPHT was reported to be 81% in adults after status epilepticus [11] and 87% in children with benign convulsions with mild gastroenteritis [9]. The rate of seizure cessation following treatment with cMDL as second-line therapy was reported to be 49% in pediatric patients with status epilepticus [7].…”

“…There are several reports regarding efficacy of fPHT or cMDL treatment [7][8][9]11]. fPHT has been reported to be effective in a few retrospective studies [8,9,11]. The rate of seizure cessation following treatment with fPHT was 65% in a study of pediatric patients with status epilepticus [8].…”

Levetiracetam in der Behandlung des Status epilepticus – ein update

“…Ebenfalls nicht berücksichtigt wurde die Arbeit von Misra und Kalita [7], da sie lediglich Daten einer bereits 2013 referierten Arbeit [8,3] enthält und mit einer älteren Studie [9] aus dem gleichen Haus zu Phenytoin und Valproat bei SE vergleicht. Ebenso nicht berücksichtigt wurde eine Vergleichsstudie zwischen LEV und Fosphenytoin [10], da hier die beiden Substanzen lediglich zum Erhalt des Behandlungserfolges eingesetzt wurden, nachdem der SE durch Diazepam klinisch bereits durchbrochen war.…”