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The EcLiPSE study took a more pragmatic approach, which may have led to potential inaccuracies in determining definitive seizure cessation but this also reflects everyday practice more closely. It can be difficult in practice to determine when a seizure has stopped, and the ConSEPT authors recognised this possibility of observer bias in the study design by video recording the episodes and having them reviewed independently. A similar situation occurred in EcLiPSE, although not so pronounced because of the active cessation of seizure definition, but technically the phenytoin group had a greater time to recover. As the phenytoin infusion takes 20 minutes, patients in that group were assessed 25 minutes after the start of the infusion levetiracetam infusion only takes 5 minutes, and so patients in that group were assessed 10 minutes after the start of the infusion.
![status epilepticus status epilepticus](https://image.slidesharecdn.com/statusepilepticus-150114122634-conversion-gate02/95/status-epilepticus-5-638.jpg)
The ConSEPT authors acknowledged the challenge with the timing differences because of the infusion rates. The aim of these studies was to establish whether levetiracetam or phenytoin is better as a second-line treatment for the management of convulsive status epilepticus in children. It can be given over 5 minutes (phenytoin takes 20 minutes to infuse), is more compatible with IV fluids, has fewer drug interactions, and has a lower risk of adverse events.Īlthough small studies suggest that levetiracetam is equally effective, there have been no comparison studies…until now. Levetiracetam is an alternative to phenytoin for second-line treatment of convulsive status epilepticus. As a result, and because of its biopharmacology, it is a resource-intensive drug to make up in an emergency. Phenytoin is linked to many adverse events including liver damage, Steven-Johnson syndrome, extravasation and reports of death due to dosing errors. Most guidelines recommend phenytoin (or fosphenytoin in the US) as a second-line treatment but much less comparative work has been undertaken. However only 40-60% of patients in status have their seizures terminated with benzodiazepines, so second-line treatments are crucial. All guidelines use benzodiazepines as the first-line treatment with significant evidence to support this.
![status epilepticus status epilepticus](https://image.slideserve.com/595886/symptoms-l.jpg)
![status epilepticus status epilepticus](https://i.ytimg.com/vi/CvX3b7MF5BQ/maxresdefault.jpg)
Our focus on the management of status is to stop the seizures quickly to avoid any complications which range from requiring an RSI to neurological sequelae ( 34%) and occasionally death ( 3-5%). Convulsive status epilepticus is a common paediatric emergency with significant consequences for the patients.
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