Cargando…

Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus

BACKGROUND AND PURPOSE: Status epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduc...

Descripción completa

Detalles Bibliográficos
Autores principales: Nazir, Mudasir, Tarray, Rayees Ahmad, Asimi, Ravouf, Syed, Wajid Ali
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Epilepsy Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903044/
https://www.ncbi.nlm.nih.gov/pubmed/33659198
http://dx.doi.org/10.14581/jer.20011
_version_ 1783654660857397248
author Nazir, Mudasir
Tarray, Rayees Ahmad
Asimi, Ravouf
Syed, Wajid Ali
author_facet Nazir, Mudasir
Tarray, Rayees Ahmad
Asimi, Ravouf
Syed, Wajid Ali
author_sort Nazir, Mudasir
collection PubMed
description BACKGROUND AND PURPOSE: Status epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduced for management of SE are valproic acid and levetiracetam. METHODS: This prospective randomized study included 150 pediatric patients admitted as SE. Patients were randomized into three equal groups (50 each) to receive one of the three anticonvulsants in addition to standard treatment. Patients were monitored in hospital regarding their vitals, time to regain consciousness, and seizure recurrence. RESULTS: At 24 hours seizures were controlled in 44 patients (88%) in phenytoin group, 39 patients (78%) in levetiracetam (LEV) group and 46 patients (92%) in valproate (VAL) group (p=0.115). The mean time to regain consciousness in phenytoin, LEV and VAL groups was 122.3±45.4, 120.8±42.8, and 75.0±30.7 minutes (mean±standard deviation) respectively. Patients in VAL group regained consciousness earlier than both phenytoin and LEV group patients (p<0.0001). At 3 months follow-up, seven (14.28%) out of 49 patients in phenytoin group, 14 (28.57%) out of 49 in LEV group and two (4%) out of 50 patients in VAL group had a seizure recurrence (p=0.0032). CONCLUSIONS: In our study we found that both IV LEV and IV VAL safe and efficacious. The primary outcome, seizure recurrence at 24 hours, did not show a statistically significant difference in three groups (p>0.05). Also, seizure recurrence at 1 week did not reach a statistically significant difference. However, time to regain consciousness and seizure recurrence at 3 months was significantly less in VAL group (p<0.05).
format Online
Article
Text
id pubmed-7903044
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Korean Epilepsy Society
record_format MEDLINE/PubMed
spelling pubmed-79030442021-03-02 Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus Nazir, Mudasir Tarray, Rayees Ahmad Asimi, Ravouf Syed, Wajid Ali J Epilepsy Res Original Article BACKGROUND AND PURPOSE: Status epilepticus (SE) is a common pediatric neurological emergency that requires immediate and vigorous management. Currently, phenytoin is the most common agent used in the setting of SE following benzodiazepine for further seizure prevention. Other drugs recently introduced for management of SE are valproic acid and levetiracetam. METHODS: This prospective randomized study included 150 pediatric patients admitted as SE. Patients were randomized into three equal groups (50 each) to receive one of the three anticonvulsants in addition to standard treatment. Patients were monitored in hospital regarding their vitals, time to regain consciousness, and seizure recurrence. RESULTS: At 24 hours seizures were controlled in 44 patients (88%) in phenytoin group, 39 patients (78%) in levetiracetam (LEV) group and 46 patients (92%) in valproate (VAL) group (p=0.115). The mean time to regain consciousness in phenytoin, LEV and VAL groups was 122.3±45.4, 120.8±42.8, and 75.0±30.7 minutes (mean±standard deviation) respectively. Patients in VAL group regained consciousness earlier than both phenytoin and LEV group patients (p<0.0001). At 3 months follow-up, seven (14.28%) out of 49 patients in phenytoin group, 14 (28.57%) out of 49 in LEV group and two (4%) out of 50 patients in VAL group had a seizure recurrence (p=0.0032). CONCLUSIONS: In our study we found that both IV LEV and IV VAL safe and efficacious. The primary outcome, seizure recurrence at 24 hours, did not show a statistically significant difference in three groups (p>0.05). Also, seizure recurrence at 1 week did not reach a statistically significant difference. However, time to regain consciousness and seizure recurrence at 3 months was significantly less in VAL group (p<0.05). Korean Epilepsy Society 2020-12-31 /pmc/articles/PMC7903044/ /pubmed/33659198 http://dx.doi.org/10.14581/jer.20011 Text en Copyright © 2020 Korean Epilepsy Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Nazir, Mudasir
Tarray, Rayees Ahmad
Asimi, Ravouf
Syed, Wajid Ali
Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title_full Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title_fullStr Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title_full_unstemmed Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title_short Comparative Efficacy of IV Phenytoin, IV Valproate, and IV Levetiracetam in Childhood Status Epilepticus
title_sort comparative efficacy of iv phenytoin, iv valproate, and iv levetiracetam in childhood status epilepticus
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903044/
https://www.ncbi.nlm.nih.gov/pubmed/33659198
http://dx.doi.org/10.14581/jer.20011
work_keys_str_mv AT nazirmudasir comparativeefficacyofivphenytoinivvalproateandivlevetiracetaminchildhoodstatusepilepticus
AT tarrayrayeesahmad comparativeefficacyofivphenytoinivvalproateandivlevetiracetaminchildhoodstatusepilepticus
AT asimiravouf comparativeefficacyofivphenytoinivvalproateandivlevetiracetaminchildhoodstatusepilepticus
AT syedwajidali comparativeefficacyofivphenytoinivvalproateandivlevetiracetaminchildhoodstatusepilepticus