Methodology Score: 4/5
Usefulness Score: 3.5/5

Kapur J et al. N Engl J Med. 2019 Nov 28;381(22):2103-2113. 

Question and Methods: A multicenter, randomized, blinded, comparative-effectiveness trial to determine the efficacy and safety of fosphenytoin, valproic acid and levetiracetam, for treatment of benzodiazepine-refractory generalized convulsive status epilepticus.

Findings: No significant difference between treatment arms in the primary endpoint of seizure termination and improvement in mental status at 1h after drug infusion (seizure stopped in ~ 50%). No difference in safety outcomes (hypotension, arrhythmia, and death).

Limitations: Long-term survival and neurological outcomes were not considered.

Interpretation: Current 2nd-line antiepileptics work for only 50% of status epilepticus. Alternative approaches are required to achieve early seizure control.

By: Dr. Evelyn Tran


  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.