Johan Zelano1, Eva Kumlien. 1. Department of Neuroscience, Uppsala University, Uppsala University Hospital, 75185 Uppsala, Sweden. johan.zelano@neuro.uu.se
Abstract
BACKGROUND: The role of new antiepileptic drugs (AED) in the treatment of status epilepticus (SE) is of interest, especially in benzodiazepine-resistant status epilepticus where phenytoin is deemed inappropriate due to allergy or comorbidity. Levetiracetam (LEV) is a new AED with few side effects. It is easy to administer. Reports exist of its use in SE in adults. AIMS: To clarify the evidence for use of LEV as an alternative stage two AED in treatment of SE by a systematic review of the literature. METHOD: An online MEDLINE search identified 118 articles. The abstracts were screened for studies written in English, in which (1) at least two adults had been treated, and (2) LEV had been administered intravenously as the first AED, on its own or together with benzodiazepines. Ten studies were included. RESULTS: Out of the ten studies, seven were retrospective observational, two prospective observational, and one prospective randomized. The studies described a total of 334 patients. The most common reason for administrating LEV was that standard treatment was deemed inappropriate. The efficacy ranged from 44% to 94%, with higher efficacy reported in the retrospective studies. CONCLUSIONS: The evidence for use of LEV as an alternative stage two AED in SE is limited. The higher efficacy reported in retrospective studies indicates possible publication bias, and caution is advised when the results of these retrospective studies are considered in clinical decision-making.
BACKGROUND: The role of new antiepileptic drugs (AED) in the treatment of status epilepticus (SE) is of interest, especially in benzodiazepine-resistant status epilepticus where phenytoin is deemed inappropriate due to allergy or comorbidity. Levetiracetam (LEV) is a new AED with few side effects. It is easy to administer. Reports exist of its use in SE in adults. AIMS: To clarify the evidence for use of LEV as an alternative stage two AED in treatment of SE by a systematic review of the literature. METHOD: An online MEDLINE search identified 118 articles. The abstracts were screened for studies written in English, in which (1) at least two adults had been treated, and (2) LEV had been administered intravenously as the first AED, on its own or together with benzodiazepines. Ten studies were included. RESULTS: Out of the ten studies, seven were retrospective observational, two prospective observational, and one prospective randomized. The studies described a total of 334 patients. The most common reason for administrating LEV was that standard treatment was deemed inappropriate. The efficacy ranged from 44% to 94%, with higher efficacy reported in the retrospective studies. CONCLUSIONS: The evidence for use of LEV as an alternative stage two AED in SE is limited. The higher efficacy reported in retrospective studies indicates possible publication bias, and caution is advised when the results of these retrospective studies are considered in clinical decision-making.
Authors: Richard E Appleton; Naomi Ea Rainford; Carrol Gamble; Shrouk Messahel; Amy Humphreys; Helen Hickey; Kerry Woolfall; Louise Roper; Joanne Noblet; Elizabeth Lee; Sarah Potter; Paul Tate; Nadia Al Najjar; Anand Iyer; Vicki Evans; Mark D Lyttle Journal: Health Technol Assess Date: 2020-11 Impact factor: 4.014
Authors: Mark D Lyttle; Carrol Gamble; Shrouk Messahel; Helen Hickey; Anand Iyer; Kerry Woolfall; Amy Humphreys; Naomi E A Bacon; Louise Roper; Franz E Babl; Stuart R Dalziel; Mary Ryan; Richard E Appleton Journal: Trials Date: 2017-06-19 Impact factor: 2.279