Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled
pilot study.
Author(s): Misra UK, Kalita J, Maurya PK.
Affiliation(s): Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Raebareily Road, Lucknow 226014, India. drukmisra@rediffmail.com
Publication date & source: 2012, J Neurol. , 259(4):645-8
For the management of status epilepticus (SE), lorazepam (LOR) is recommended as
the first and phenytoin or fosphenytoin as the second choice. Both these drugs
have significant toxicity. Intravenous levetiracetam (LEV) has become available,
but its efficacy and safety has not been reported in comparison to LOR. We report
a randomized, open labeled pilot study comparing the efficacy and safety of LEV
and LOR in SE. Consecutive patients with convulsive or subtle convulsive SE were
randomized to LEV 20 mg/kg IV over 15 min or LOR 0.1 mg/kg over 2-4 min. Failure
to control SE within 10 min of administration of one study drug was treated by
the other study drug. The primary endpoint was clinical seizure cessation and
secondary endpoints were 24 h freedom from seizure, hospital mortality, and
adverse events. Our results are based on 79 patients. Both LEV and LOR were
equally effective. In the first instance, the SE was controlled by LEV in 76.3%
(29/38) and by LOR in 75.6% (31/41) of patients. In those resistant to the above
regimen, LEV controlled SE in 70.0% (7/10) and LOR in 88.9% (8/9) patients. The
24-h freedom from seizure was also comparable: by LEV in 79.3% (23/29) and LOR in
67.7% (21/31). LOR was associated with significantly higher need of artificial
ventilation and insignificantly higher frequency of hypotension. For the
treatment of SE, LEV is an alternative to LOR and may be preferred in patients
with respiratory compromise and hypotension.
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