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Levetiracetam as second-line treatment of status epilepticus – which dose should be applied? Cover

Levetiracetam as second-line treatment of status epilepticus – which dose should be applied?

Open Access
|Jul 2021

Figures & Tables

Figure 1.

Efficacy rates of different Levetiracetam loading doses.
Efficacy rates of different Levetiracetam loading doses.

Figure 2.

Relative efficacy rates in comparison to 20 mg/kg Phenytoin of different Levetiracetam loading doses.
Relative efficacy rates in comparison to 20 mg/kg Phenytoin of different Levetiracetam loading doses.

Studies with administration of 20–25 mg/kg Levetiracetam

ReferenceCriterium of efficacyLEV group n =DosageEfficacy rateEfficacy rate of comparator
Misra et al., 2012Not clearly defined for patients who received LEV after LZP1020 mg/kg70%LZP 1 mg/kg 88.9%
Mundlamuri et al., 2015No recurrence of seizures after 30 minutes of infusion of study drugs5025 mg/kg78%PHT 20 mg/kg 68%, VPA 30 mg/kg 68%
Chakravarthi et al., 2015Termination of seizure activity within 30 min after the beginning of the drug infusion2220 mg/kg59.1%PHT 20 mg/kg 68%
Wongjirattikarn et al., 2019Seizure control within 24 hours after drug administration20 brand LEV/20 generic LEV20 mg/kg75%/65%n.a.
Nene et al., 2019No recurrence of seizures after half an hour of infusion of study drugs5820-25mg/kg74,1%VPA 20-25 mg/kg 68,3%
Vignesh et al., 2020Control of convulsive status epilepticus at the end of 15 minutes after completion of study drug infusion (20 minutes)3220 mg/kg94%PHT 20 mg/kg 89%, VPA 20 mg/kg 83%
Nazir et al., 202024 h.5025 mg/kg78%VPA 25 mg/kg 92%, PHT 20 mg/kg 88%

Studies with administration of 40 mg/kg Levetiracetam

ReferenceCriterium of efficacyLEV group n =Efficacy rateEfficacy rate of comparator
Lyttle et al., 2019Median time from randomization to seizure cessation 35 min.15270%PHT 20 mg/kg 64%
Dalziel et al., 2019Cessation of seizure activity 5 min after completion of infusion of the first trial drug.11950%PHT 20 mg/kg 60%
Noureen et al., 2019Cessation of a clinical seizure within 30 minutes after the end of drug adminitstration30092,7%PHT 20 mg/kg 83,3%
Wani et al., 2019No clear time frame before additional “mini bolus”5271%*PHT 20 mg/kg 46,1%
Nalisetty et al., 2020Seizure termination within 20 minutes after infusion3293,75%fPHT 20 mg/kg PHT equivalents 69%
Appleton et al., 2020舢median time to seizure cessation 35 min in the LEV group”15270%PHT 20 mg/kg 64%

Studies with administration of 60 mg/kg Levetiracetam

ReferenceCriterium of efficacyLEV group n =DosageEfficacy rateEfficacy rate of comparator
Chamberlain et al., 2020Absence of clinically apparent seizures with improved consciousness and without additional ASM at 1 h from start of drug infusion.C: 225 A: 186 E: 5160 mg/kgC: 52% A: 44% E: 37%C: VPA 40 mg/kg 52%, fPHT 20 mg/kg PHT eq 49% A: VPA 46%, fPHT 46% E: VPA 47%, fPHT 35%

Studies with administration of 30 mg/kg Levetiracetam

ReferenceCriterium of efficacyLEV group n =Efficacy rateEfficacy rate of comparator
Gujjar et al., 2017Control of seizures with no recurrence over next 24 h2282%PHT 20 mg/kg 73,3%
Handral et al., 2020Cessation of seizures within 10-20 min following the end of the infusion5891,4%HT 30 mg/kg 93,1%
DOI: https://doi.org/10.21307/joepi-2021-001 | Journal eISSN: 2299-9728 | Journal ISSN: 2300-0147
Language: English
Page range: 7 - 12
Submitted on: May 21, 2021
Accepted on: Jul 15, 2021
Published on: Jul 27, 2021
Published by: The Foundation of Epileptology
In partnership with: Paradigm Publishing Services
Publication frequency: 2 issues per year

© 2021 Johannes Rösche, Bernd Schade, published by The Foundation of Epileptology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.