Abstracts

Rationale: Acute management of status epilepticus (SE) and acute repetitive seizure (ARS) is critical to prevent deleterious neurologic complications. Intravenous (IV) phenobarbital is the most commonly used antiepileptic drug for benzodiazepine refractory SE in children, the significant adverse effects such as deep sedation and drug interactions limited the use of phenobarbital. To examine the potential use of IV levetiracetam as an alternative of IV phenobarbital, we compared the efficacy and tolerability of IV levetiracetam and phenobarbital in children with SE or ARS. Methods: We retrospectively reviewed the data of children (aged 1month - 15 years) treated with IV phenobarbital and levetiracetam for SE or ARS in our single tertiary center. Seizure termination was defined as the seizure cessation within 30 minutes of infusion completion and no recurrence within the following 24 hours. Demographic variables, EEG, MRI findings, previous antiepileptic medications, and adverse events after the drug infusion were also reviewed. Student's t-test was used for two group comparisons. Results: Eighty-eight patients with SE or ARS (median age, 18 months), 50 patients with phenobarbital and 38 patients with levetiracetam, were evaluated. The median initial dose of phenobarbital was 20 (range,10-20) mg/kg/dose and that of levetiracetam was 30 (range,20-30) mg/kg/dose. IV levetiracetam was successful in seizure termination in 57.9% (22/38) of patients and IV phenobarbital was in 74.0% (37/50). The efficacy of two antiepileptic drugs was not significantly different (p=0.111) and other clinical variables were not significantly different between two groups. Adverse effects were found in 5 (13.2%) of the levetiracetam group, four with aggressive behavior and one with vomiting, and in 14 (28.0%) of the phenobarbital group (p=0.094). Conclusions: IV levetiracetam can be an efficacious and safe alternative antiepileptic drug for IV phenobarbital in children with SE or ARS.