title: Intravenous levetiracetam: a new treatment alternative for refractory status epilepticus.
abstract: The purpose of this study was to investigate the safety and efficacy of intravenous levetiracetam (LEV-iv) in refractory status epilepticus (SE). A retrospective chart review was performed on patients who received LEV-iv for treatment of SE (n = 36) and had failed at least one other antiepileptic drug. LEV-iv (median 3000 mg/day; range 1000-9000) was administered as a bolus loading (500-2000 mg per 30-60 min, n = 30) or as a continuous pump infusion (n = 6). SE was terminated in 69% ("responders"); 31% ("non-responders") remained in SE. Factors associated with failure were: dose escalation over 3000 mg/day, lack of bolus loading, treatment latency over 48 h, age over 80 years, non-convulsive SE with coma ("subtle SE"), periodic lateralised epileptiform discharges (PLEDs) on EEG, acute cerebral lesion and intubation narcosis. SE was terminated in all eight patients without brain lesion (p = 0.033), and in all seven patients with complex partial SE (p = 0.051). Outcome was favourable (ambulatory patients) in 48% (responders) compared with 0% (non-responders), and "adverse" (death or continuing coma/stupor) in 24% (responders) compared with 100% (non-responders). Mortality was 17% (responders 4%, non-responders 45%). No patient had cardiocirculatory side effects or worsening of SE. Two patients experienced nausea and vomiting during LEV-iv loading, leading to aspiration pneumonia in one. This study suggests that LEV-iv may be a safe and efficacious treatment of SE. Prospective and controlled trials are imperative to confirm these preliminary findings.
authors.affiliation: Department of Neurology, University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany. moddel@uni-muenster.de
authors.forename: G
authors.initials: G
authors.lastname: Möddel
authors.forename: S
authors.initials: S
authors.lastname: Bunten
authors.forename: C
authors.initials: C
authors.lastname: Dobis
authors.forename: S
authors.initials: S
authors.lastname: Kovac
authors.forename: M
authors.initials: M
authors.lastname: Dogan
authors.forename: M
authors.initials: M
authors.lastname: Fischera
authors.forename: R
authors.initials: R
authors.lastname: Dziewas
authors.forename: W-R
authors.initials: WR
authors.lastname: Schäbitz
authors.forename: S
authors.initials: S
authors.lastname: Evers
authors.forename: S
authors.initials: S
authors.lastname: Happe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D000077287:Levetiracetam; D008297:Male; D008875:Middle Aged; D010889:Piracetam / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam