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.