Because of the lack of studies comparing the efficacy and safety of levetiracetam and valproate before the induction of general anesthesia in the treatment of convulsive refractory status epilepticus in children, we aimed to compare the effectiveness of these antiepileptic drugs in patients with convulsive status epilepticus admitted to the Pediatric Intensive Care Unit between 2011 and 2014. Forty-six (59%) of the 78 patients received levetiracetam, and 32 (41%) received valproate for the treatment of refractory status epilepticus. The response rate was not significantly different between the 2 groups. Although no adverse event was noted in patients who received levetiracetam, 4 (12.5%) patients in the valproate group experienced liver dysfunction (P = .025). According to our results, levetiracetam and valproate may be used in the treatment of refractory status epilepticus before the induction of general anesthesia. Levetiracetam appears as effective as valproate, and also safer.
ChinRFNevilleBGScottRC. A systematic review of the epidemiology of status epilepticus. Eur J Neurol. 2004;11:800–810.
2.
DeLorenzoRJHauserWATowneAR. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46:1029–1035.
3.
ChinRFNevilleBGPeckhamC. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Lancet. 2006;368:222–229.
4.
Raspall-ChaureMChinRFNevilleBGScottRC. Outcome of paediatric convulsive status epilepticus: a systematic review. Lancet Neurol. 2006;5:769–779.
5.
SahinMMenacheCCHolmesGLRivielloJJ. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42:1461–1467.
6.
ShorvonSBaulacMCrossHTrinkaEWalkerM; TaskForce on Status Epilepticus of the ILAE Commission for European Affairs. The drug treatment of status epilepticus in Europe: consensus document from a workshop at the first London Colloquium on Status Epilepticus. Epilepsia. 2008;49:1277–1285.
7.
Sánchez FernándezIAbendNSAgadiS. Gaps and opportunities in refractory status epilepticus research in children: a multi-center approach by the Pediatric Status Epilepticus Research Group (pSERG). Seizure. 2014;23:87–97.
8.
AbendNSDlugosDJ. Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatr Neurol. 2008;38:377–390.
9.
BrophyGMBellRClaassenJ. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17:3–23.
10.
SchreiberJMGaillardWD. Treatment of refractory status epilepticus in childhood. Curr Neurol Neurosci Rep. 2011;11:195–204.
11.
TrinkaE. The use of valproate and new antiepileptic drugs in status epilepticus. Epilepsia. 2007;48:49–51.
12.
AbendNSLoddenkemperT. Management of pediatric status epilepticus. Curr Treat Options Neurol. 2014;16:301.
13.
SasidaranKSinghiSSinghiP. Management of acute seizure and status epilepticus in pediatric emergency. Indian J Pediatr. 2012;79:510–517.
14.
CapovillaGBeccariaFBeghiEMinicucciFSartoriSVecchiM. Treatment of convulsive status epilepticus in childhood: recommendations of the Italian League Against Epilepsy. Epilepsia. 2013;54:23–34.
15.
MastrangeloMCelatoA. Diagnostic work-up and therapeutic options in management of pediatric status epilepticus. World J Pediatr. 2012;8:109–115.
16.
RajDGulatiSLodhaR. Status epilepticus. Indian J Pediatr. 2011;78:219–226.
17.
SofouKKristjánsdóttirRPapachatzakisNEAhmadzadehAUvebrantP. Management of prolonged seizures and status epilepticus in childhood: a systematic review. J Child Neurol. 2009;24:918–926.
18.
Mehta V, Singhi P, Singhi S. Intravenous sodium valproate versus diazepam infusion for the control of refractory status epilepticus in children: a randomized controlled trial. J Child Neurol. 2007;22:1191–1197.
19.
UberallMATrollmannRWunsiedlerUWenzelD. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology. 2000;54:2188–2189.
20.
YuKTMillsSThompsonNCunananC. Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia. 2003;44:724–726.
21.
MishraDSharmaSSankhyanN. Consensus guidelines on management of childhood convulsive status epilepticus. Indian Pediatr. 2014;51:975–990.
22.
KirmaniBFCrispEDKayaniSRajabH. Role of intravenous LEV in acute seizure management of children. Pediatr Neurol. 2009;41:37–39.
23.
GorayaJSKhuranaDSValenciaI. Intravenous LEV in children with epilepsy. Pediatr Neurol. 2008;38:177–180.
24.
NgYTHastriterEVCardenasJFKhouryEMChapmanKE. Intravenous LEV in children with seizures: a prospective safety study. J Child Neurol. 2010;25:551–555.
25.
GallentineWBHunnicuttASHusainAM. LEV in children with refractory status epilepticus. Epilepsy Behav. 2009;14:215–218.
26.
KimJSLeeJHRyuHW. Effectiveness of intravenous LEV as an adjunctive treatment in pediatric refractory status epilepticus. Pediatr Emerg Care. 2014;30:525–528.
27.
AbendNSMonkHMLichtDJDlugosDJ. Intravenous LEV in critically ill children with status epilepticus or acute repetitive seizures. Pediatr Crit Care Med. 2009;10:505–510.
28.
McTagueAKneenRKumarRSpintySAppletonR. Intravenous LEV in acute repetitive seizures and status epilepticus in children: experience from a children’s hospital. Seizure. 2012;21:529–534.
29.
KirmaniBFCrispEDKayaniSRajabH. Role of intravenous LEV in acute seizure management of children. Pediatr Neurol. 2009;41:37–39.
30.
WhelessJWTreimanDM. The role of the newer antiepileptic drugs in the treatment of generalized convulsive status epilepticus. Epilepsia. 2008;49:74–78.
31.
TripathiMVibhaDChoudharyN. Management of refractory status epilepticus at a tertiary care centre in a developing country. Seizure. 2010;19:109–111.
32.
Commission on classification and terminology of the International League Against Epilepsy Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981;22:489–501.
33.
ShinnarSBergATMosheSLShinnarR. How long do new-onset seizures in children last?Ann Neurol. 2001;49:659–664.
34.
DeLorenzoRJGarnettLKTowneAR. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia. 1999;40:164–169.
35.
LowensteinDHBleckTMacdonaldRL. It’s time to revise the definition of status epilepticus. Epilepsia. 1999;40:120–122.
36.
TrinkaECockHHesdorfferD. A definition and classification of status epilepticus—report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015;56:1515–1523.
37.
WasterlainCGChenJW. Definition and classification of status epilepticus. In WasterlainCGTreimanDM, eds. Status Epilepticus. Cambridge, MA: MIT Press; 2006;11–16.
38.
WilkesRTaskerRC. Pediatric intensive care treatment of uncontrolled status epilepticus. Crit Care Clin. 2013;29:239–257.
39.
OwensJ. Medical management of refractory status epilepticus. Semin Pediatr Neurol. 2010;17:176–181.
40.
AbendNSBeardenDHelbigI. Status epilepticus and refractory status epilepticus management. Semin Pediatr Neurol. 2014;21:263–274.
41.
PollackMMPatelKMRuttimannUE. PRISM III. An updated Pediatric Risk of Mortality score. Crit Care Med. 1996;24:743–752.
42.
BergATBerkovicSFBrodieMJ. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51:676–685.
43.
KwanPArzimanoglouABergAT. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies. Epilepsia. 2010;51:1069–1077.
44.
LacroixJDealCGauthierMRousseauEFarrellCA. Admissions to a pediatric intensive care unit for status epilepticus: a 10-year experience. Crit Care Med. 1994;22:827–832.
45.
ChinRFVerhulstLNevilleBGPetersMJScottRC. Inappropriate emergency management of status epilepticus in children contributes to need for intensive care. J Neurol Neurosurg Psychiatry. 2004;75:1584–1588.
46.
WilkesRTaskerRC. Intensive care treatment of uncontrolled status epilepticus in children: systematic literature search of midazolam and anesthetic therapies. Pediatr Crit Care Med. 2014;15:632–639.
47.
BennettKS. Pediatric refractory status epilepticus: many more questions than answers. Pediatr Crit Care Med. 2014;15:674–676.
48.
ChengLLeiSChenSH. Pretreatment with intravenous LEV in the rhesus monkey Coriaria lactone-induced status epilepticus model. J Neurol Sci. 2015;348:111–120.
49.
LeeDSRyuHJKimJE. The effect of LEV on status epilepticus-induced neuronal death in the rat hippocampus. Seizure. 2013;22:368–377.
50.
KimJSLeeJHRyuHW. Effectiveness of intravenous LEV as an adjunctive treatment in pediatric refractory status epilepticus. Pediatr Emerg Care. 2014;30:525–528.
