Why we prefer levetiracetam over phenytoin for treatment of status epilepticus.

Abstract:

:Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine-resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time-consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine-resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.

journal_name

Acta Neurol Scand

authors

Zaccara G,Giorgi FS,Amantini A,Giannasi G,Campostrini R,Giovannelli F,Paganini M,Nazerian P,Tuscany study group on seizures in the emergency department and status epilepticus in adults.

doi

10.1111/ane.12928

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

618-622

issue

6

eissn

0001-6314

issn

1600-0404

journal_volume

137

pub_type

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