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Convulsive status epilepticus (CSE) is a medical emergency that requires prompt treatment. While there is high-quality evidence to support use of benzodiazepines as first-line therapy for CSE, the historical use of phenytoin as the second-line therapy for benzodiazepine-resistant seizures is based on limited evidence.1 Phenytoin has several disadvantages including a long infusion time, drug interactions, a narrow therapeutic index and adverse events such as cardiac arrhythmias, hepatotoxicity, pancytopenia and Stevens-Johnson syndrome. Since the approval of an intravenous formulation of levetiracetam in 2006, it has been considered as an alternative medication for use in benzodiazepine-resistant CSE as it can be administered quickly as an intravenous push, has minimal drug interactions, reliable pharmacokinetics and few serious side effects. Thus, there has been a recent explosion in the number of randomised controlled trials (RCTs) comparing the safety and efficacy of levetiracetam for benzodiazepine-resistant CSE, with 10 RCTs reported since 2018. Similarly, in light of recent data on safety and efficacy of levetiracetam, at least three systematic reviews with meta-analyses are reported so …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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