IV Levetiracetam versus IV Phenytoin in Childhood Seizures: A Randomized Controlled Trial.

ABSTRACT

OBJECTIVES: To compare the efficacy of IV phenytoin and IV levetiracetam in acute seizures. DESIGN: Randomized controlled trial. SETTING: Tertiary care hospital, November 2012 to April 2014. PATIENTS 100 children aged 3-12 yrs of age presenting with acute seizures. INTERVENTION Participants randomly received either IV phenytoin 20 mg/kg (n = 50) or IV levetiracetam 30 mg/kg (n = 50). Patients who were had seizures at presentation received IV diazepam prior to these drugs. OUTCOME MEASURES: Primary Absence of seizure activity within next 24 hrs.Secondary Stopping of clinical seizure activity within 20 mins of first intervention, change in cardiorespiratory parameters, and achievement of therapeutic drug levels. RESULTS: Two groups were comparable in patient characteristics and seizure type (P > 0.05). Of the 100 children, 3 in levetiracetam and 2 in phenytoin group had a repeat seizure in 24 hrs, efficacy was comparable (94% vs 96%, P > 0.05). Of these, 18 (36%) in phenytoin and 12 (24%) in levetiracetam group received diazepam. Sedation time was 178.80 ±97.534 mins in phenytoin and 145.50 ±105.208 mins in levetiracetam group (P = 0.346). Changes in cardiorespiratory parameters were similar in both groups except a lower diastolic blood pressure with phenytoin (P = 0.023). Therapeutic drug levels were achieved in 38 (76%) children both at 4 and 24 hrs with phenytoin, compared to 50 (100%) and 48 (98%) at 1 and 24 hrs with levetiracetam (P < 0.05). CONCLUSION: Intravenous levetiracetam and phenytoin have similar efficacy in preventing seizure recurrences for 24 hrs in children 3-12 years presenting with acute seizures.