Abstracts

Rationale: Refractory status epilepticus (RSE) is defined as seizure activity lasting longer than 60 minutes despite adequate treatment with intravenous anti-epileptic drugs (AEDs). RSE is frequently encountered in children, and is associated with significant morbidity and mortality. AEDs currently used in its management are frequently associated with life threatening side effects. Levetiracetam (LEV) use as adjuvant therapy in adult patients with RSE has recently been reported, and felt to be beneficial without any associated adverse effects. LEV may have an important role in the management of RSE in children. The primary objective of this study was to evaluate the experience with LEV in children with RSE at a tertiary care referral center. Methods: The records of children (ages 0-16 years) admitted to Duke University Medical Center between 1/1/2000-11/1/20006 with EEG confirmed seizures lasting longer than 60 minutes who were refractory to standard SE treatment protocols were reviewed. Patients requiring continuous intravenous infusions of midazolam or pentobarbital were also considered for inclusion. Of these children, those who received LEV as adjunctive therapy (via nasogastric tube, rectally, or intravenously) were then included in the study. This study was approved by the Institutional Review Board. Results: A total of 83 cases of RSE were reviewed; 5 had received LEV orally, rectally, via nasogastric tube, or intravenously. Patient ages ranged from 2 days to 9 years (mean 4.6). Prior to receiving LEV, the number of previously tried AEDs ranged from 4-9 (mean 6.2). Starting dose of LEV ranged from 20 mg/kg to 70 mg/kg. One patient, had resolution of RSE 48 hours after initiation of 40 mg/kg of LEV. Three patients who had previously been unable to be weaned off continuous midazolam or pentobarbital infusions were weaned successfully 24-96 hours after LEV administration at doses of 30-40 mg/kg. One patient receiving LEV and topiramate per rectum developed rectal bleeding; both AEDs were discontinued. Later LEV was restarted orally and was tolerated well. No other adverse events were reported.Conclusions: RSE in children is difficult to treat, and often requires combinations of AEDs. LEV may be beneficial as adjuvant therapy in children with RSE. It may also be a safer alternative is these patients. (Acknowledgement: This study was funded in part by UCB Pharmaceuticals.)