Abstract
Objective: Status epilepticus is a major emergency condition. The choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial, including levetiracetam vs. fosphenytoin. We compare the safety of intravenous levetiracetam and fosphenytoin as a second-line treatment in patients with status epilepticus using a nationwide database.Methods: An observational study conducted with the Japanese Diagnosis Procedure Combination inpatient database identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam on the day of admission from March 1, 2011 to March 31, 2018. Patients who received intravenous levetiracetam on the day of admission were defined as the levetiracetam group and those who received intravenous fosphenytoin on the day of admission were defined as the fosphenytoin group. Propensity score matching was performed to compare outcomes obtained for the levetiracetam and fosphenytoin groups.Results: The analysis examined data of 5,667 patients. Overall, 1,403 (25%) patients received levetiracetam; 4,264 (75%) received fosphenytoin. One-to-one propensity score matching created 1,363 matched pairs. No significant difference was found in in-hospital mortality (5.2 vs. 5.1%; odds ratio, 1.03; 95% confidence interval, 0.73–1.46). The proportion of vasopressor use on the day of admission was significantly lower for the levetiracetam group than for the fosphenytoin group (3.2 vs. 4.9%; odds ratio, 0.63; 95% confidence interval, 0.43–0.92). No significant difference was found in other secondary outcomes including total hospitalization cost.Conclusion: Levetiracetam was related to significantly reduced vasopressor use on the day of admission than that found for fosphenytoin, in adult status epilepticus.
Highlights
Status epilepticus (SE) is a major medical emergency condition, and failure to treat SE would cause death or irreversible cerebral damage [1, 2]
Patients who received intravenous levetiracetam on the day of admission were defined as the levetiracetam group and those who received intravenous fosphenytoin on the day of admission were defined as the fosphenytoin group
The proportion of vasopressor use on the day of admission was significantly lower for the levetiracetam group than for the fosphenytoin group (3.2 vs. 4.9%; odds ratio, 0.63; 95% confidence interval, 0.43–0.92)
Summary
Status epilepticus (SE) is a major medical emergency condition, and failure to treat SE would cause death or irreversible cerebral damage [1, 2]. Benzodiazepines are used as first-line treatment for SE [3, 4]. Second-line treatments of longeracting antiepileptic drugs (AEDs) are administered to prevent recurrence [5]. The choice of AEDs for second-line treatment remains controversial. Phenytoin and fosphenytoin have been used as second-line treatment [6]. Levetiracetam, a new AED, binds to the synaptic vesicle protein 2A and regulates the release of neurotransmitters. Earlier observational studies show that levetiracetam is effective and that it is associated with less adverse effects than those of phenytoin [7,8,9,10,11]. Neurocritical Care Society guidelines recommended levetiracetam use in addition to phenytoin/fosphenytoin [5], but other guidelines do not recommend levetiracetam use [15, 16]
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