Levetiracetam versus phenytoin in management of status epilepticus

The purpose of this study was to compare safety and efficacy of intravenous (IV) levetiracetam (LEV) with IV phenytoin (PHT) in management of status epilepticus (SE). The second-line treatment of SE is limited to a few drugs available in an IV formulation such as PHT, fosphenytoin and valproate. The relative lack of serious side effects and favourable pharmacokinetics of LEV made it a promising option in management of SE. Randomized trials comparing relative efficacy of second-line agents are remarkably lacking. In this study, consecutive patients of SE (n = 44) were randomized to receive either IV PHT (20 mg/kg) or IV LEV (20 mg/kg). The primary end point was successful clinical termination of seizure activity within 30 min after the beginning of the drug infusion. Secondary end points included recurrence of seizures within 24 hours, drug related adverse effects, neurological outcome at discharge, need for ventilatory assistance, and mortality during hospitalization. Both LEV and PHT were equally effective with regard to primary and secondary outcome measures. PHT achieved control of SE in 15 (68.2%) patients compared to LEV in 13 (59.1%; p = 0.53). Both the groups showed comparable results with respect to recurrence of seizures within 24 hours (p = 0.34), outcome at discharge as assessed by functional independence measure (p = 0.68), need of ventilatory assistance (p = 0.47) and death (p = 1). From this study it can be concluded that LEV may be an attractive and effective alternative to PHT in management of SE.