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Review
. 2023 Feb 1;9(2):e13380.
doi: 10.1016/j.heliyon.2023.e13380. eCollection 2023 Feb.

Efficacy and safety of levetiracetam versus valproate in patients with established status epilepticus: A systematic review and meta-analysis

Shixin Wang  1 , Xin Wu  2 , Tao Xue  3 , Zhaoming Song  1 , Xin Tan  4 , Xiaoou Sun  1 , Zhong Wang  1
Affiliations
Review

Efficacy and safety of levetiracetam versus valproate in patients with established status epilepticus: A systematic review and meta-analysis

Shixin Wang et al. Heliyon. .

Abstract

Objective: Status epilepticus (SE) is a common neurological emergency that is defined as a prolonged seizure or a series of seizures which often leads to irreversible damage. Levetiracetam (LEV) and valproate (VPA) are second-line anti-seizure drugs that are frequently used in patients with established SE (ESE). This meta-analysis compared the efficacy and safety of LEV and VPA for the treatment of ESE.

Method: MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched by two authors, which identified six randomized controlled trials (RCTs) that compared LEV and VPA for ESE.

Results: The six RCTs included 1213 patients (LEV group, n = 593; VPA group, n = 620). Integrated patient data information display LEV was not superior to VPA in terms of clinical seizure termination (63.55% vs. 64.08%, respectively; relative risk [RR] = 1.03, 95% confidence interval [CI] = 0.94-1.11, p = 0.55), with no significant differences between LEV and VPA in terms of good functional outcome at discharge (Glasgow Outcome Scale [GOS] = 4 or 5), intensive care unit (ICU) admission, adverse events, and mortality. There was no statistically significant difference between the two drugs in different age groups. Previous multicenter studies have demonstrated that VPA was slightly more effective than LEV, whereas single-center studies showed the opposite results. In addition, LEV and VPA had similar rates of clinical seizure termination, ICU admission, and adverse events between the age subgroups (ages <18 and >18 years).

Conclusions: Levetiracetam (LEV) was not superior to valproate (VPA) in terms of efficacy or safety outcomes. In addition, children (<18 years) and adults (>18 years) might have similar responses to LEV and VPA. Additional RCTs are required to verify our results.

Keywords: Established status epilepticus; Levetiracetam; Meta-analysis; Valproate.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study search, selection, and inclusion process.
Fig. 2
Fig. 2
Pooled relative risk of the efficacy outcomes. Diamond indicates the estimated relative risk (95% confidence interval) for all patients. a. Clinical seizure termination. b. Good functional ability at discharge (GOS = 4 or 5).
Fig. 3
Fig. 3
Pooled relative risk of safety outcomes. Diamond indicates the estimated relative risk (95% confidence interval) for all patients.
Fig. 4
Fig. 4
Subgroup analysis of levetiracetam (LEV) dose (similar to the comparison of single- and multi-center studies, as well as studies conducted in countries with different levels of economic development). Diamond indicates the estimated relative risk (95% confidence interval) for all patients.
Fig. 5
Fig. 5
Risk of bias: A summary table for each risk of bias item for each study.
See this image and copyright information in PMC

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