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