Alternative Treatment For Convulsive Status Epilepticus

Every day 87 people are diagnosed with epilepsy within the UK, where it affects over 600,000 people. Those with epilepsy may experience memory loss and other cognitive problems, however the cause of these problems remains unknown. Among children the annual incidence is 20 per 100,000 children, and it is the second most common reason for unplanned admissions to intensive care units.

Anticonvulsants are typically used to control seizures in those with epilepsy experiencing convulsive status epilepticus, which is when tonic-clonic seizures won’t stop on its own or with anticonvulsants; this is the most most life threatening neurological emergency among children.

Convulsive status epilepticus is treated using an algorithm which incorporates 10 minute intervals between treatments; second line treatment is given when convulsive status epilepticus persists after 2 doses of benzodiazepine or the patient’s personalised emergency rescue treatment.

Phenytoin has been used as the second line treatment for convulsive status epilepticus for several decades which can have rare but dangerous side effects. Levetiracetam has been suggested to possibly be an effective and safer alternative to phenytoin.

To determine which treatment was most effective and safest the EcLiPSE Team conducted a randomised clinical trial between 2014 and 2018 to compare the efficacy and safety of both drugs as a second line management for convulsive status epilepticus involving 30 Emergency Departments in the UK and almost 300 children.

Trial results did not show levetiracetam to be better than phenytoin in stopping convulsive status epilepticus, however results suggest levetiracetam may be considered as an alternative treatment to phenytoin.

"Our results suggest that levetiracetam could be considered as an alternative treatment to phenytoin for second-line management of paediatric CSE. Possible benefits of levetiracetam over phenytoin include its ease of preparation and administration, minimal interaction with antiepilepsy and other drugs, and easy conversion to oral maintenance therapy. Further randomised clinical trial and meta-analysis data could help to confirm our results and might lead to levetiracetam being the preferred second-line anticonvulsant in children with benzodiazepine-resistant convulsive status epilepticus. The trial also highlights the importance of close and effective collaboration between two specialities in paediatrics, neurology and emergency medicine that will improve the care of children with epilepsy." according to the researchers.