Abstract
With the advent of new antiepileptic drugs comes the potential for significant advances in the emergent management of status epilepticus. Traditional antiepileptic drugs possess side effect profiles that may limit their clinical utility or lead to increased patient morbidity or mortality. The relatively recent development of levetiracetam shows promise for effective control of acute status epilepticus in adults, but current objective data of its use as a first-line agent for control of status is quite limited. This paper serves to examine existing literature while considering levetiracetam as a first-line therapy in status in the adult patient population. Although existing studies are narrow in their scope, the present data lay a substantial foundation for further investigation of levetiracetam as a primary therapy in acute status epilepticus.
Highlights
The emergent management of status epilepticus has been restricted to a small subset of antiepileptic drugs suitable for acute intravenous infusion
Of the three major traditional drugs used in first-line therapy for status, each carries a side effect profile that may lend to limited clinical utility in the critical patient
Given multiple case reports of successful use of levetiracetam as an initial agent in the emergent treatment of status, there is certainly basis for the development of larger scale randomized controlled trials allowing for a direct, standardized comparison between traditional first-line agents and levetiracetam for emergent management of status epilepticus
Summary
The emergent management of status epilepticus has been restricted to a small subset of antiepileptic drugs suitable for acute intravenous infusion. Phenytoin, and phenobarbital individually convey specific risks to the patient, among them respiratory depression, medication interaction due to cyp[450] induction, and teratogenicity (1) Each of these known effects may complicate their use in an urgent setting and contribute to increased morbidity in patients presenting with status epilepticus (1). The reasoning behind the traditional management of status is perhaps most apparent in Brophy et al.’s (7) discussion of the Neurocritical Care Society’s Status Epilepticus Guideline Writing Committee, which set forth parameters for a stepwise approach to the management of status epilepticus (7) This initial set of standards favored benzodiazepine therapy as a first-line modality citing the utility of the multiple administration routes and rapid infusion times common to many benzodiazepines, most notably lorazepam, and midazolam (7). While the committee limited their recommendations for the emergent control of status epilepticus to benzodiazepines, levetiracetam was given a strong recommendation for urgent control www.frontiersin.org
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