Abstracts

Rationale: Status epilepticus (SE) is one of the most common neurological emergencies and is defined as greater than 5 minutes of persistent clinical or electrographic seizure activity. Phenytoin (PHT) has been the gold standard second line treatment for benzodiazepine (BZD) refractory SE. Levetiracetam (LVT) has been a popular anti-epileptic drug (AED) for this purpose as well. As disparity in use increases more investigation is needed to look at the efficacy and outcomes. Methods: Selected patients were 18 years and older, who presented in BZD refractory SE between 2013-2015, and had received LVT, PHT, or both as second line agents. 70 patients were identified during this 3 year period. Electroencephalogram (EEG) monitoring from our neuro- diagnostic center and Crimson/Midas databases were utilized. Patients were grouped into PHT (fPHT/PHT), LVT, and combined groups. Characteristics of age, gender, diagnosis, etiology, pattern of first and last EEG, need for intubation, need for a third line agent, length of stay, GOS at discharge, disposition, and whether the patient was discharged on the parent AED was collected. Data was analyzed using the Fisher exact test for categorical values, Kruskal-Wallis test for continuous values, and the Bonferroni-adjusted pair-wise comparison for differences between each group Results: Of 70 patients 29 were treated with LVT, 18 with PHT, and 23 with both agents for BZD refractory SE. The average age was younger in the PHT group (42), followed by the LVT group (49), followed by both (56). P-value 0.07. Although statistical significance was not reached, perhaps less comorbidities in the younger patients lead to the decision for PHT, while the more favorable side effect profile of LVT lead to its use in older patients.Diagnosis of clinical SE was made in 48 (69%), NCSE in 16 (23%), and focal SE in 6 (9%). Of 48 with clinical SE 48% were treated with LVT, 27% with PHT, and 25% with both. Of 16 with NCSE 50% were treated with both, 31% with LVT, and 19% with PHT. Of 6 with focal SE 50% were treated with both, 33% with PHT, and 17% with LVT. P-value 0.27. Although not reaching statistical significance, the most common seizure type was clinical SE, which was more likely to be treated with LVT. Second was NCSE, with most patients treated with both. Last was focal SE, with most patients treated with both. There was no statistical difference between the etiology of seizures and the treatment group. P-value 0.95. No statistical difference was observed between the LVT and PHT groups regarding cessation of EEG activity. P-value 0.345. AED and need for intubation showed no statistical difference between the three groups. P-value 0.95. The average LOS was 9 days in the LVT group, 12 days in the PHT group, and 12 days in the combined group. P-value 0.2. Although statistical significance was not seen, it appears there was a trend towards shorter LOS in the LVT group, averaging 3 days less than both the PHT and combined groups. The average GOS at discharge was 4 (moderate disability) among all groups without statistical significance. P-value 0.75. No statistical difference seen between disposition and treatment group. P-value 0.73. Conclusions: No statistical difference was found between LVT and PHT in terms of efficacy or outcomes in the treatment of BZD refractory status epilepticus. LVT and PHT were equally efficacious in cessation of clinical and electrographic status epilepticus. No statistical difference was found between the seizure etiology and the agent utilized. Patients treated with LVT and PHT had similar Glasgow Outcome Scales at discharge, without a statistical difference. This study confirms the results published by Chakravarthi et al and Bachhuber et al. Funding: None