Second-line anticonvulsants for paediatric convulsive status epilepticus

The cause and the management of convulsive status epilepticus are the two most important factors in determining its outcome.1 Benzodiazepines are the recommended first-line drug treatment of convulsive status epilepticus and for which reasonably good scientific evidence based on a number of randomis...

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Bibliographic Details
Published in:The Lancet (British edition) 2020-04, Vol.395 (10231), p.1172-1173
Main Author: Appleton, Richard E
Format: Article
Language:English
Subjects:
Age
Anesthesia
Anticonvulsants
Benzodiazepines
Child
Children
Double-Blind Method
Emergency medical care
Epilepsy
Etiracetam
Humans
Intravenous administration
Levetiracetam
Management
Neurological complications
Pediatrics
Phenytoin
Phenytoin - analogs & derivatives
Randomization
Side effects
Status Epilepticus
Valproic Acid
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Summary:The cause and the management of convulsive status epilepticus are the two most important factors in determining its outcome.1 Benzodiazepines are the recommended first-line drug treatment of convulsive status epilepticus and for which reasonably good scientific evidence based on a number of randomised controlled trials exists to support their use.2 Intravenous phenytoin in the UK and fosphenytoin in the USA are the current recommended first-choice, second-line drug treatments in children aged 6 months and older,3–5 but until recently, this choice has not been based on good randomised controlled trial evidence. Additionally, phenytoin, and, perhaps to a lesser degree, fosphenytoin, is known to be associated with severe and potentially fatal adverse side-effects.8 Now, within a 12-month period, three large randomised controlled trials have reported the efficacy and safety of phenytoin or fosphenytoin compared with levetiracetam and valproate in the management of convulsive status epilepticus in approximately 750 children overall, aged 3 months to 18 years. In The Lancet, James Chamberlain and colleagues7 report on an extension of ESETT,6 after extending enrolment among children.7 ESETT was a double-blind, randomised controlled trial in which 225 children (aged 2–17 years; 55% male) and 237 adults (186 aged 18–65 years; 58% male; and 51 aged >65 years; 41% male) were randomly assigned in a Bayesian response-adaptive manner to fosphenytoin, levetiracetam, or valproate.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(20)30674-7