Clinical Trials for the Use of Anti-Epileptic Drugs in SE

Clinical Trials for the Use of Anti-Epileptic Drugs in SE

Author	Design/Sample	Intervention and Comparison	Outcome
Chakravathi et al, 2015	Prospective, Randomized, Open-LabelN=44	IV Leviteracetam 20 mg/kg infused at 100 mg/mgVsIV Phenytoin 20 mg/kg infused over 30 minutes; max rate 50 mg/min	No difference in seizure termination or seizure recurrence More adverse effects in Phenytoin
Guijjar et al, 2017	Prospective, Randomized, Open-LabelN= 52	IV Leviteracetam 20 mg/kg infused over 30 minutesVsIV Phenytoin 20 mg/kg infused over 30 minutes	No difference in seizure termination or outcome at discharge Less severe adverse effects in IV Leviteracetam group
Nakamura et al, 2017	ObservativeN=63	IV Leviteracetam 1000mg infused over 30 minutesVsFosphenytoin 22.5 mg/kg	No difference in seizure cessation, adverse effects
Dalziel et al, 2019	Prospective, Randomized, Open-LabelN= 52	IV or IO Leviteracetam 40 mg/kg over 5 minutesVsIV or IO Phenytoin 20 mg/kg over 20 minutes	No difference in seizure termination or seizure recurrence
Lyttle et al, 2019	Prospective, Randomized, Open-LabelN= 286	IV Leviteracetam 40 mg/kg over 5 minutesVsIV Phenytoin 20 mg/kg over 20 minutes	No difference in time to seizure cessation
Shaner et al, 1998	Prospective, Randomized, Non-blindedN=36	IV Diazepam 2 mg/min up to 20 mg + IV Phenytoin, up to 18 mg/kgVsPhenobarbital 10 mg/kg	Phenobarbital is as effective as IV Diazepam + IV Phenytoin
Misra et al, 2006	Prospective, Randomized Pilot Study, used as first-lie and second-line AEDN=68	IV Pheytoin 18 mg/kgVsIV Valproic Acid30 mg/kg	IV Valproic Acid is more effective than IV Phenytoin
Agarwal et al, 2007	Prospective, Randomized, Non-blinded, Refractory to IV DiazepamN=100	IV Pheytoin 20 mg/kgVsIV Valproic Acid20 mg/kg	IV Valproic Acid is equivalent to IV Phenytoin
Gilad et al, 2008	Prospective, Randomized, Without prior Benzodiazepine AdministrationN=74	IV Pheytoin 18 mg/kgVsIV Valproic Acid30 mg/kg	IV Valproic Acid is equivalent to IV Phenytoin
Alvarez et al, 2011	Retrospective, Non-randomized, Refractory to BenzodiazepinesN=187	IV Pheytoin 20 mg/kgVsIV Leviteracetam20 mg/kg	IV Leviteracetam is less effective than IV Valproic Acid No significant difference between IV Valproic Acid and IV Phenytoin
Misra et al, 2012	Prospective, Randomized, Open-Label Pilot StudyN=79	IV Leviteracetam20 mg/kgVsIV Lorazepammg/kg	IV Leviteracetam is equivalent to IV Lorazepam
Mundlamuri, 2015	RCTN=150	IV Valproic Acid30 mg/kgVsIV Leviteracetam25 mg/kgVsIV Phenytoin20 mg/kg	No statistically significant difference for control of SE
Kapur et al, 2019	Randomized, Double-blind, Adaptive Comparative Effectiveness TrialN=400	IV Leviteracetam 60 mg/kg, max dose 4500mgVsIV Fosphenytoin 20 mgPE/kg, max dose 1500 mgPEVsIV Valproate 40 mg/kg, max dose 3000mg	No significant difference in seizure cessation among the AED group Hypotension and Endotracheal intubation were more frequent with IV Leviteracetam

Conclusions

IV Phenytoin and IV Leviteracetam show no significant difference in terms of seizure cessation but IV Phenytoin showed more adverse effects
Some studies show IV Valproic Acid to be better than IV Phenytoin but some conclude both drugs to have no significant difference as an AED drug for SE
IV Leviteracetam shows more adverse effects but is equally effective with IV Valproic Acid and IV Fosphenytoin
Despite the less frequent usage due to its long half-life, Phenobarbital is as effective as IV Diazepam + IV Phenytoin

Pharmacotherapy of Status Epilepticus

Background

Participants 396

Clinical Trials for the Use of Anti-Epileptic Drugs in SE

Clinical Trials for the Use of Anti-Epileptic Drugs in SE

Conclusions