Journal of Neurology

, Volume 259, Issue 4, pp 645–648

Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study

Original Communication

Abstract

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.

Keywords

Status epileptics Antiepileptic drug Lorazepam Levetiracetam Benzodiazepine Sodium valproate 

References

  1. 1.
    Alldredge BK, Gelb AM, Isaacs SM, Corry MD, Allen F, Ulrich S, Gottwald MD, O’Neil N, Neuhaus JM, Segal MR, Lowenstein DH (2001) A comparison of lorazepam, diazepam, and placebo for the treatment of out-of-hospital status epilepticus. N Engl J Med 345:631–637PubMedCrossRefGoogle Scholar
  2. 2.
    Claassen J, Hirsch LJ, Mayer SA (2003) Treatment of status epilepticus: a survey of neurologists. J Neurol Sci 211:37–41PubMedCrossRefGoogle Scholar
  3. 3.
    De Smedt T, Raedt R, Vonck K, Boon P (2007) Levetiracetam: part II, the clinical profile of a novel anticonvulsant drug. CNS Drug Rev 13(1):57–78PubMedCrossRefGoogle Scholar
  4. 4.
    Knake S, Gruener J, Hattemer K, Klein MK, Bauer S, Oertel HW, Hamer HM, Rosenow F (2008) Intravenous levetiracetam in the treatment of benzodiazepine refractory status epilepticus. J Neurol Neurosurg Psychiatry 79:588–589PubMedCrossRefGoogle Scholar
  5. 5.
    Leppik IE, Derivan AT, Homan RW, Walker J, Ramsay RE, Patrick B (1983) Double-blind study of lorazepam and diazepam in status epilepticus. JAMA 249:1452–1454PubMedCrossRefGoogle Scholar
  6. 6.
    Misra UK, Kalita J, Patel R (2006) Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology 67:340–342PubMedCrossRefGoogle Scholar
  7. 7.
    Ng YT, Hastriter EV, Cardenas JF, Khoury EM, Chapman KE (2010) Intravenous levetiracetam in children with seizures: a prospective safety study. J Child Neurol 25:551–555PubMedCrossRefGoogle Scholar
  8. 8.
    O’Brien TJ, Cascino GD, So EL, Hanna DR (1998) Incidence and clinical consequence of the purple glove syndrome in patients receiving intravenous phenytoin. Neurology 51:1034–1039PubMedGoogle Scholar
  9. 9.
    Ramael S, Daoust A, Otoul C, Toublanc N, Troenaru M, Lu ZS, Stockis A (2006) Levetiracetam intravenous infusion: a randomized, placebo-controlled safety and pharmacokinetic study. Epilepsia 47:1128–1135PubMedCrossRefGoogle Scholar
  10. 10.
    Ruegg S, Naegelin Y, Hardmeier M, Winkler DT, Marsch S, Fuhr P (2008) Intravenous levetiracetam: treatment experience with the first 50 critically ill patients. Epilepsy Behav 12:477–480PubMedCrossRefGoogle Scholar
  11. 11.
    Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE, Mamdani MB (1998) A comparison of four treatments for generalized convulsive status epilepticus. Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 339:792–798PubMedCrossRefGoogle Scholar
  12. 12.
    Tripathi M, Vibha D, Choudhary N, Prasad K, Srivastava MV, Bhatia R, Chandra SP (2010) Management of refractory status epilepticus at a tertiary care centre in a developing country. Seizure 19:109–111PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of NeurologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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