Date of Award
Selective Evidence-Based Medicine Review
Master of Science in Health Sciences - Physician Assistant
Physician Assistant Studies
Objective: The objective of this selective EBM review is to determine whether or not “Is levetiracetam more effective than phenytoin in seizure cessation in children with convulsive status epilepticus that don’t respond to first-line treatment?”
Study design: Systematic review of three randomized controlled trials (RCTs) published in peerreviewed journals in English in 2019. Data Sources: Three RCTs published in peer reviewed journals were found using Alt HealthWatch, AMED, CINAHL Plus, and Scopus.
Outcome(s) Measured: Clinical cessation of seizure, defined as cessation of continuous rhythmic clonic activity, was measured by the investigator after infusion of treatment.
Results: The study by Dalziel et al. showed a higher rate of seizure cessation in the phenytoin group compared to the levetiracetam group as well as a clinically significant NNT of -10. However, with a p-value of 0.18 and a 95% CI of -23.6 to 4.2 the results were not statistically significant. In the study by Noureen et al. the rates of seizure cessation in the levetiracetam group were significantly higher than those in the phenytoin group (P-value = 0.01). In the study by Lyttle et al. there was a higher rate of seizure cessation in the levetiracetam group compared to the phenytoin group along with an NNT of 10, however the results were not statistically significant with a p value of 0.20.
Conclusions: The only study in this selective EBM review to yield statistically significant results showed that levetiracetam is more effective than phenytoin in seizure cessation in children with convulsive status epilepticus that don’t respond to first-line treatment. Due to the variability of the results and limitations of each study, further research is needed to provide a more concrete answer to the question at hand. Additionally, studies analyzing the safety and efficacy of using both phenytoin and levetiracetam together as second line treatment may provide critical information regarding the treatment of CSE in the future.
Santiago, Sydney A., "Is levetiracetam more effective than phenytoin in seizure cessation in children with convulsive status epilepticus that don’t respond to first-line treatment?" (2021). PCOM Physician Assistant Studies Student Scholarship. 587.