In Pediatric Status Epilepticus, Levetiracetam Is Not Superior to Phenytoin as a Second-Line Therapy

Most seizures stop without intervention and do not progress to status epilepticus, and most cases of status epilepticus resolve with one or two adequate doses of benzodiazepines. Although many medication options exist, there is little evidence to guide the choice of a second-line agent when benzodiazepines fail. Two open-label multicenter randomized trials compared the efficacy and safety of phenytoin (20 mg/kg infused over 20 minutes) versus levetiracetam (40 mg/kg infused over 5 minutes) for the treatment of pediatric status epilepticus refractory to two doses of benzodiazepines.

The ConSEPT trial enrolled 233 children aged 3 months to 16 years in Australia and New Zealand who were not taking either study medication at baseline. Convulsion…