The Status on Status: Management of Status Epilepticus

Status epilepticus (SE) is considered one of the most common neurological emergencies with an estimated incidence of 20 cases/100,000 people worldwide. Just the facts The distribution is bimodal, peaking in patients <1 and >60 years old.  In children, the cause is predominantly from febrile illnesses, with or without infection, and in adults it is largely secondary to acute damage from […]

Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus

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 […]

Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial

Methodology: 4/5 Usefulness: 4/5 Lyttle MD, et al. Lancet. 2019 May 25;393(10186):2125-2134. Question and Methods: Eclipse was an open label RCT that evaluated time to seizure cessation in pediatric SE between Keppra and Dilantin Findings: They found that Keppra was not superior (HR 1.2, 95%CI 0.91-1.60, p= 0.20) to Dilantin for the treatment of SE Limitations: Limited somewhat by study […]

Lorazepam vs diazepam for pediatric status epilepticus: a randomized clinical trial

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2.5/5  Chamberlain JM, et al; Pediatric Emergency Care Applied Research Network (PECARN). JAMA.2014 Apr 23-30;311(16):1652-60. doi: 10.1001/jama.2014.2625. Full Article   This double-blind, multi-center, superiority RCT (N=273) found that first-line treatment of pediatric status epilepticus with Lorazepam IV was not superior to Diazepam IV in seizure cessation (72.9% vs 72.1%) or need for ventilation (17.6% […]