Levetiracetam vs. phenytoin for cluster seizures
Trial question
What is the role of intravenous levetiracetam in patients with cluster seizures?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
30.0% female
70.0% male
N = 63
63 patients (19 female, 44 male).
Inclusion criteria: adult patients with cluster seizures, following an initial dose of IV benzodiazepine to control ongoing seizure.
Key exclusion criteria: known allergy to drugs used; requiring immediate neurosurgery; hemodynamic compromise; serious arrhythmias; pregnancy; cardiac failure or pulmonary edema; pre-terminal states; having pseudo-seizures.
Interventions
N=38 levetiracetam (intravenous dosage of 30 mg/kg over 30 minutes).
N=25 phenytoin (intravenous dosage of 20 mg/kg over 30 min for status epilepticus and cluster seizures).
Primary outcome
Seizure control over 24 hour
81.6%
80%
81.6 %
61.2 %
40.8 %
20.4 %
0.0 %
Levetiracetam
Phenytoin
No significant
difference ↔
No significant difference in seizure control over 24 hour (81.6% vs. 80%; RR 1.02, 95% CI -10.33 to 12.37).
Secondary outcomes
Significant decrease in poor outcome with modified Rankin score 4-6 (21% vs. 44%; RR 0.48, 95% CI 0 to 0.96).
Safety outcomes
No significant difference in adverse events.
Conclusion
In adult patients with cluster seizures, following an initial dose of IV benzodiazepine to control ongoing seizure, levetiracetam was not superior to phenytoin with respect to seizure control over 24 hour.
Reference
Arunodaya R Gujjar, Ramachandiran Nandhagopal, Poovathoor C Jacob et al. Intravenous levetiracetam vs phenytoin for status epilepticus and cluster seizures: A prospective, randomized study. Seizure. 2017 Jul;49:8-12.
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