Up to 1/3 of status epilepticus do not respond to benzodiazepines.
Fosphenytoin, valproate, and levetiracetam are 3 antiepileptic medications commonly used to treat benzodiazepine-resistant status epilepticus, though it is unclear which is more effective.
Results from the long awaited Established Status Epilepticus Treatment Trial (ESETT) has just been released.
Fosphenytoin, valproate, and levetiracetam each achieved seizure cessation within 1 hour in approximately 50% of patients.
80% of responders had seizure cessation within 20 minutes.
Seizure recurrence was observed in 10% of each treatment group.
It is important to note the dosages of antiepileptic medications used were:
Fosphenytoin 20 mg PE/kg, max 1500 mg
Valproate 40 mg/kg, max 3000 mg
Levetiracetam 60 mg/kg, max 4500 mg
Bottom Line: Fosphenytoin, valproate, and levetiracetaim have similar efficacy in treatment of benzodiazepine-resistant status epilepticus.
References
Kapur J, Elm J, Chamberlain JM, et al. Randomized trial of three anticonvulsant medications for status epilepticus. N Engl J Med. 2019;381:2013-13.
