Efficacy of parenteral phenytoin, valproate and levetiracetam in the treatment of convulsive status epilepticus: a randomized controlled study

Status epilepticus (SE) is a one of the neurological emergency with significant mortality and morbidity. The AEDs currently approved for management of SE after the usage of benzodiazepine, are phenytoin, fosphenytoin, sodium valproate cannot be administered often in patients with hepatic, renal or cardiac dysfunctions and most of these AEDs have potential drug interactions with concurrent AEDs or other medications. For the last few years, intravenous levetiracetam have been introduced in clinical practice and it has shown promising results in various retrospective studies. There are no systematic RCT comparing phenytoin, sodium valproate and levetiracetam after administering lorazepam in patients with generalized convulsive SE (GCSE). 

As per the current guidelines, once SE is refractory i.e. not controlled with benzodiazepines and another AED i.e. either phenytoin or valproate, it is advised to provide an ICU care with ventilator, with anaesthetic agents like midazolam, thiopentone or propofol. The benefits of such early treatment is unquestionable. But, the problems are non-availability of ventilatory ICU beds especially in resource poor settings like India; higher incidence of ICU infections; and anaesthetic medication induced side effects. Moreover, there is no definite evidence that aggressive treatment with anaesthetic agents in refractory SE will improve the outcome.

Therefore, this prospective study was conducted as a randomised controlled study to compare the efficacy of phenytoin, valproate sodium and levetiracetam along with lorazepam as first line in patients with GCSE at this centre.