Objective:

The purpose of this study is to evaluate weight-based dosing of levetiracetam for efficacy in terminating seizures and provide guidance on the optimal dose for status epilepticus. 

Background:

Status epilepticus is a neurological emergency in which prompt treatment is imperative in reducing morbidity and mortality. First line treatment is benzodiazepines, however one-third of patients remain refractory. The ESETT trial had established that levetiracetam, phenytoin, and valproic acid are equally efficacious in second-line treatment for status epilepticus. In that trial, levetiracetam is dosed at 60mg/kg, maximum 4500mg. The American Epilepsy Society has recommended this weight-based regimen, the Neurocritical Care Society recommends a dose of 1000-3000mg IV, and prior studies investigating success of interventions had a dosing range from 20-60mg/kg. There is currently no official consensus of ideal dosing of levetiracetam in status epilepticus.  

Design/Methods:

This retrospective study includes adult patients who received at least one dose of IV levetiracetam in the Emergency Department for treatment of status epilepticus. The primary endpoint is to compare weight-based dosing (40-60 mg/kg, maximum 4500mg) with non-weight-based dosing of levetiracetam for efficacy in terminating seizures within 6 hours. The secondary endpoint is admission into the ICU and endotracheal intubation within 24 hours. 

Results:

Based on interim results, the weight-based dose group has higher rates of successful termination of status epilepticus (n=5; 100%) compared to the non-weight-based group (n=43; 65.12%) (p=0.17). The weight-based dose group has lower rates of admission into the ICU (0% vs 25.58%) (p=0.58) and endotracheal intubation within 24 hours (0% vs 9.3%)  (p=0.63) compared to the non-weight-based group.

Conclusions:

Interim results show a non-statistically significant benefit in weight based dosing of levetiracetam for termination of status epilepticus, reduced ICU admission, and endotracheal intubation. Limitations include a small sample size of patients in the weight based dosing group. Data collection and statistical analysis is ongoing.