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Efficacy of intravenous levetiracetam versus phenytoin in convulsive status epilepticus and acute repetitive seizures in children

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Abstract

Purpose

Phenytoin is one of the most used antiepileptic drugs (AEDs), but it has serious potential side effects and drug interactions. Although studies have shown levetiracetam to have a much lower side-effect profile, its efficacy when compared with phenytoin is debatable. In our study, we aimed to determine the factors that cause seizure recurrence and to compare the efficacy of levetiracetam and phenytoin in the treatment of convulsive status epilepticus (CSE) and acute repetitive seizures (ARS).

Methods

In this study, 185 patients diagnosed with CSE or ARS and aged between 1 month and 18 years who received intravenous levetiracetam or phenytoin as a second-line AED were retrospectively evaluated.

Results

A total of 185 patients were included in the study, 85 (45.9%) girls and 100 (54.1%) boys.While 54.1% (n = 100) of the patients were given phenytoin, levetiracetam was administered to 45.9% (n = 85) of them. The rates of cessation of seizure and prevention of seizure recurrence for 24 h were 84% for phenytoin and 78.8% for levetiracetam, without a significant difference (p > 0.05). Having active seizures on admission to the emergency department and an age of < 36 months were significantly related to seizure recurrence (p < 0.01).

Conclusions

Our results support that the intravenous administration of levetiracetam as the second-line treatment for CSE and ARS in children is as effective as the intravenous administration of phenytoin.

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Authors and Affiliations

  1. Department of Pediatrics, Kartal Dr. Lütfi Kırdar City Hospital, University of Health Science, Istanbul, Turkey

    Mehmet Tolga Köle, Safiye Günes Sager, Hatice Zeynel, Yakup Çağ & Yasemin Akın

Authors
  1. Mehmet Tolga Köle
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  2. Safiye Günes Sager
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  3. Hatice Zeynel
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  4. Yakup Çağ
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  5. Yasemin Akın
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Contributions

MTK and SGS analyzed the data and drafted the manuscript. MTK critically reviewed the analyses. MTK, SGS, HZ, YC, and YA reviewed and commented on initial and final drafts of the manuscript. All authors have participated in drafting of the manuscript and/or critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehmet Tolga Köle.

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Ethical approval

The study was approved by the Institutional Ethics Committee of the hospital on October 27, 2021. (Registration Number: 2021/514/212/13). The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.

Conflict of interest

The authors declare no competing interests.

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Köle, M.T., Sager, S.G., Zeynel, H. et al. Efficacy of intravenous levetiracetam versus phenytoin in convulsive status epilepticus and acute repetitive seizures in children. Childs Nerv Syst 38, 1357–1364 (2022). https://doi.org/10.1007/s00381-022-05543-2

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  • DOI: https://doi.org/10.1007/s00381-022-05543-2

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