Levetiracetam for convulsive status epilepticus in childhood: systematic review and meta-analysis

Abstract

ImportanceProlonged seizures are life-threatening emergencies associated with significant morbidity.ObjectiveTo determine the efficacy and safety of levetiracetam in treating convulsive status epilepticus (CSE) in childhood.Data sources and study selectionsPubMed, Embase, the Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature were searched from inception up to April 2020. Only randomised controlled trials (RCTs) that included children aged 1 month–18 years were assessed. Two reviewers performed data assessment and extraction.Data extraction and synthesisTen studies out of the 20 637 citations identified were included.Main outcomesCessation of seizure activities, time to cessation of seizure activities, need for rapid sequence intubation (RSI), intensive care unit (ICU) admission, recurrence of seizures at 24 hours, adverse events and all-cause mortality.ResultsWe included 10 RCTs (n=1907). There was no significant difference in cessation of seizure activities when levetiracetam was compared with phenytoin (risk ratio (RR)=1.03, 95% CI 0.98 to 1.09), levetiracetam to fosphenytoin (RR=1.16, 95% CI 1.00 to 1.35) or levetiracetam to valproate (RR=1.10, 95% CI 0.94 to 1.27). No differences were found in relation to the timing of cessation of seizures for levetiracetam versus phenytoin (mean difference (MD)=−0.45, 95% CI −1.83 to 0.93), or levetiracetam versus fosphenytoin (MD=−0.70, 95% CI −4.26 to 2.86). There were no significant differences with regard to ICU admissions, adverse events, recurrence of seizure at 24 hours, RSI and all-cause mortality.ConclusionLevetiracetam is comparable to phenytoin, fosphenytoin and valproate as a second line treatment of paediatric CSE.

Optimal Management of Status Epilepticus in Children in the Emergency Setting: A Review of Recent Advances

“…Their pooled data also showed that there was no statistically significant difference in seizure termination rates or time to seizure termination in the two groups. A sub-analysis mirrored the earlier, 2020 meta-analysis 46 in that statistically more patients treated with fosphenytoin compared to levetiracetam experienced adverse drug events, respiratory depression and acute hypotension and also required more assisted respiratory support (p = 0.002). These differences were not seen in the levetiracetam and phenytoin comparison (p = 0.06).…”

“…44 An earlier meta-analysis suggested that sodium valproate was being increasingly used in the management of CSE, particularly in adults, despite the lack of good efficacy and safety data. 45 A systematic review and meta-analysis by Abdelgadir et al in 2020 46 and also by Feng et al in 2021 47 both concluded that levetiracetam is comparable to phenytoin (or fosphenytoin) but has the advantage of being superior in safety outcomes. Abdelgadir et al 46 included only RCTs, which comprised of 10 studies involving 1907 children.…”

“…45 A systematic review and meta-analysis by Abdelgadir et al in 2020 46 and also by Feng et al in 2021 47 both concluded that levetiracetam is comparable to phenytoin (or fosphenytoin) but has the advantage of being superior in safety outcomes. Abdelgadir et al 46 included only RCTs, which comprised of 10 studies involving 1907 children. Seven of the 10 studies compared levetiracetam to phenytoin (1640 children) and three compared levetiracetam to fosphenytoin or sodium valproate.…”