Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam.

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Version: Author's accepted manuscript
Serval ID
serval:BIB_E5D8FA98F3A1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Second-line status epilepticus treatment: comparison of phenytoin, valproate, and levetiracetam.
Journal
Epilepsia
Author(s)
Alvarez V., Januel J.M., Burnand B., Rossetti A.O.
ISSN
1528-1167 (Electronic)
ISSN-L
0013-9580
Publication state
Published
Issued date
07/2011
Peer-reviewed
Oui
Volume
52
Number
7
Pages
1292-1296
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Phenytoin (PHT), valproic acid (VPA), or levetiracetam (LEV) are commonly used as second-line treatment of status epilepticus (SE), but comparative studies are not available.
Among 279 adult SE episodes identified prospectively in our tertiary care hospital over 4 years, we retrospectively identified 187 episodes in which PHT, VPA, or LEV were given after benzodiazepines. Patients with postanoxic SE were not included. Demographics, clinical SE features, failure of second-line treatment to control SE, new handicap, and mortality at hospital discharge were assessed. Uni- and multivariable statistical analyses were applied to compare the three agents.
Each compound was used in about one third of SE episodes. VPA failed to control SE in 25.4%, PHT in 41.4%, and LEV in 48.3% of episodes in which these were prescribed. A deadly etiology was more frequent in the VPA group, whereas SE episodes tended to be more severe in the PHT group. After adjustment for these known SE outcome predictors, LEV failed more often than VPA [odds ratio (OR) 2.69; 95% confidence interval (CI) 1.19-6.08]; 16.8% (95% CI: 6.0-31.4%) of second-line treatment failures could be attributed to LEV. PHT was not statistically different from the other two compounds. Second-line treatment did not seem to influence new handicap and mortality, whereas etiology and the SE Severity Score (STESS) were robust independent predictors.
Even without significant differences on outcome at discharge, LEV seems less efficient than VPA to control SE after benzodiazepines. A prospective comparative trial is needed to address this potentially concerning finding.

Keywords
Aged, Analysis of Variance, Anticonvulsants/therapeutic use, Chi-Square Distribution, Female, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Phenytoin/therapeutic use, Piracetam/analogs & derivatives, Piracetam/therapeutic use, Retrospective Studies, Status Epilepticus/drug therapy, Treatment Failure, Valproic Acid/therapeutic use
Pubmed
Web of science
Open Access
Yes
Create date
13/04/2011 14:02
Last modification date
20/08/2019 16:09
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