Seizure Therapy With Intravenous Levetiracetam and Lorazepam

The study will enroll adults (age at least 18 years) in the EDs of MGH or BWH. Patients will be classified, depending upon their clinical presentation, into the SE group or the non-SE group. The total enrollment projected for non-SE patients is 150; the total enrollment projected for SE patients is 200. It is expected that at least 3 years may be required to enroll the requisite number of patients.

Patients are eligible for study enrollment if they have had a seizure, and if they do not have known pregnancy or renal failure, and if they are not known to be breastfeeding. Hypotension is the only other exclusion criteria for the study. There are no other contraindications to study enrollment.

Patients evaluated at the MGH/BWH EDs for seizures may arrive by private vehicle or ambulance. A "STILL" pager will be activated by ED physicians upon notification of impending ambulance arrival with a suspected seizure patient (SE or non-SE); the pager can also be activated after patient arrival at the ED by ambulance or private vehicle.

Upon patient arrival to the ED, standard stabilization will be provided. If the patient is determined to have had a seizure, or if the patient is currently seizing, an IV will be placed (if not already present) in line with standard ED care. For the patient to be eligible for STILL, the seizure must have occurred within an hour of ED arrival.

Care providers will make a determination as to whether patients are eligible, using a checklist readily available in the ED. For patients who are determined to be eligible, the care providers will indicate whether patients are in the "SE" or "non-SE" arm - the study groups are hereafter denoted SE and non-SE.