Research Analysis: Status epilepticus: Pick your antidote

A multicenter randomized control trial reveals that all drugs are created equal, at least when it comes to levetiracetam, fosphenytoin and valproate

Results from the Established Status Epilepticus Treatment Trial (ESETT) were recently published in New England Journal of Medicine (NEJM), providing medical directors with a research-centric resource to turn to when epileptic patients don’t respond to traditional benzodiazepines.

Specifically, ESETT was an NIH and FDA funded joint effort by the Neurological Emergencies Treatment Trials (NETT) Network and the Pediatric Emergency Care Applied Research Network (PECARN) in which adult and pediatric patients in an emergency department setting were randomized to either levetiracetam (i.e. Keppra), fosphenytoin (i.e. Cerebyx) or valproate (i.e. Depakene or Epival).

The study was performed across 57 hospital emergency departments by a mixture of pediatric, adult and combined facilities. Patients were eligible if they had received “adequate” doses of benzodiazepines by EMS or the ED and their convulsions had either never stopped or they had a recurrent seizure within 30 minutes of the last benzodiazepine.

The outcome of interest after receipt of one of the trial drugs was the absence of any clinically apparent seizure as well as improvement in responsiveness at the 60-minute mark. This had to be achieved without additional anticonvulsants or paralytics.

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