R.E.B.E.L.EM - December 23, 2019 - By Salim Rezaie
Ref: Kapur J et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. NEJM 2019. PMID: 31774955
"Author Conclusion: “In the context of benzodiazepine-refractory convulsive status epilepticus, the anticonvulsant drugs levetiracetam, fosphenytoin, and valproate each led to seizure cessation and improved alertness by 60 minutes in approximately half the patients, and the three drugs were associated with similar incidences of adverse events.”
Clinical Take Home Point: However you want to take this study…half glass full or half glass empty, one thing is for sure…letting patients seize for >1hr is simply unacceptable. Pick the medication that is safest and easiest to give (for me this is levetiracetam) and give it with the second benzodiazepine dose. If this is unsuccessful in stopping the seizure, then quickly move on to ketamine and/or propofol."