Although Keppra has been used more frequently in clinical practice, there is little evidence for its use in status epilepticus.
It has a wide spectrum of action and few drug interactions.
Initially, case series appeared to be highly successful in terminating seizures as an add-on agent.
A review of 2 prospective studies found efficacies of 44% as an add- on agent, and 75% as a primary agent. The studies had markedly different populations.
In a retrospective study, the treatment failure rates were 3X higher than that of intravenous valproic acid as an add-on agent in terminating status epilepticus.
Therefore, although it is used frequently, the evidence for use is limited and inconclusive in terminating status epilepticus.
References
Trinka E. What is the evidence to use new intravenous AED in status epilepticus? Epilepsia 2011 52(Suppl 8):35-8.
Zelano J, Kumlien E. Levetiracetam as alternative stage two antiepileptic drug in status epilepticus: A systematic review. Seizure 2012. 21:233-6.
