First10EM - April 21, 2019 - By Justin Morgenstern
..."Bottom line
Despite the excitement, these trials do not provide strong evidence in support of levetiracetam. These trials say that levetiracetam is not better than phenytoin. They also don’t show any difference in adverse events. This is consistent with all prior RCTs.
We should be careful not to claim that these trials demonstrate that the two agents are equivalent, because they do not.
I will probably continue to use phenytoin or valproate, until someone can show me any good science that demonstrates benefit from this new, highly hyped agent. (Although, my treatment is often decided by local protocols, rather than pure science). You may have other reasons to choose levetiracetam, and you should always consider all available evidence as well as your own clinical expertise when making a decision. There is nothing here that says you shouldn’t choose levetiracetam, but it is a more expensive agent, with less overall clinical experience, and no evidence of superiority.
There isn’t enough evidence to be definitive either way, but I remain skeptical of the hype surrounding levetiracetam."