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Levetiracetam for convulsive status epilepticus in childhood: systematic review and meta-analysis
  1. Ibtihal Abdelgadir1,2,
  2. Ali Hamud1,
  3. Ayodeji Kadri1,
  4. Shazia Akram1,
  5. Abdul Pullattayi1,
  6. Anthony K Akobeng1,
  7. Colin Powell1,3
  1. 1Department of Emergency Medicine, Sidra Medicine, Doha, Qatar
  2. 2Pediatrics, Weill Cornell Medical College in Qatar, Doha, Qatar
  3. 3Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
  1. Correspondence to Professor Colin Powell, Emergency Medicine, Sidra Medical and Research Center, Doha CF14 4XN, Qatar; PowellC7{at}cardiff.ac.uk

Abstract

Importance Prolonged seizures are life-threatening emergencies associated with significant morbidity.

Objective To determine the efficacy and safety of levetiracetam in treating convulsive status epilepticus (CSE) in childhood.

Data sources and study selections PubMed, Embase, the Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature were searched from inception up to April 2020. Only randomised controlled trials (RCTs) that included children aged 1 month–18 years were assessed. Two reviewers performed data assessment and extraction.

Data extraction and synthesis Ten studies out of the 20 637 citations identified were included.

Main outcomes Cessation of seizure activities, time to cessation of seizure activities, need for rapid sequence intubation (RSI), intensive care unit (ICU) admission, recurrence of seizures at 24 hours, adverse events and all-cause mortality.

Results We included 10 RCTs (n=1907). There was no significant difference in cessation of seizure activities when levetiracetam was compared with phenytoin (risk ratio (RR)=1.03, 95% CI 0.98 to 1.09), levetiracetam to fosphenytoin (RR=1.16, 95% CI 1.00 to 1.35) or levetiracetam to valproate (RR=1.10, 95% CI 0.94 to 1.27). No differences were found in relation to the timing of cessation of seizures for levetiracetam versus phenytoin (mean difference (MD)=−0.45, 95% CI −1.83 to 0.93), or levetiracetam versus fosphenytoin (MD=−0.70, 95% CI −4.26 to 2.86). There were no significant differences with regard to ICU admissions, adverse events, recurrence of seizure at 24 hours, RSI and all-cause mortality.

Conclusion Levetiracetam is comparable to phenytoin, fosphenytoin and valproate as a second line treatment of paediatric CSE.

  • neurology
  • pharmacology
  • therapeutics
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Footnotes

  • Correction notice This paper has been updated since it was published online. The first author's surname was incorrect.

  • Contributors All authors have been involved with contributions to the conception and design of the systematic review, search strategy, study selection, data extraction, data analysis and synthesis; they have all been involved with drafting the work and revising it critically for important intellectual content; have all given final approval of the version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. IA contributed to the study design, data extraction and meta-analysis, wrote the initial manuscript, reviewed, revised and approved the submitted manuscript. AH contributed to the study design, search and paper selection, data extraction, edited the initial manuscript, and reviewed, revised and approved the submitted manuscript. AK contributed to the study design, search and paper selection, data extraction, edited the initial manuscript, and reviewed, revised and approved the submitted manuscript. SA contributed to the study design, search and paper selection, data extraction, edited the initial manuscript, and reviewed, revised and approved the submitted manuscript. AP contributed to the study design, search and paper selection, reviewed, and revised and approved the submitted manuscript. AKA contributed to the study design, search and paper selection, data extraction, edited the initial manuscript, reviewed, revised and approved the submitted manuscript. CP contributed to the study design, search and paper selection, data extraction, edited the initial manuscript, and reviewed, revised and approved the submitted manuscript.

  • 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.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. No further data available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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