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Status epilepticus

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Note: conundrums are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

After Benzos, what is your first drug for status epilepticus?

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pemsou5_wp • December 27, 2019

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  1. Kelly January 6, 2020 - 2:18 pm Reply

    Several recently published large RCTs have not been able to show superiority of one anti-convulsant over another. The EcLiPSE trial done in 30 UK EDs and the ConSEPT trial done in 13 Australia and New Zealand EDs randomized children (< 16-18yo) in status who failed benzodiazepines to phenytoin 20 mg/kg over 20 minutes or levetiracetam 40 mg/kg over 5 minutes – neither trial showed superiority of one of the drugs. (Both were published in the May 25, 2019 issue of The Lancet). The ESETT trial published in the November 28, 2019 issue of NEJM randomized children and adults in status who failed benzodiazepine therapy to either fosphenytoin 20 mg/kg, valproate 40 mg/kg, or levetiracetam 60 mg/kg over 10 minutes. They did not show superiority of any of the drugs, and each led to seizure resolution in about half of the patients.

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