Efficacy and safety of levetiracetam for pediatric convulsive status epilepticus in emergency settings: a systematic review and meta-analysis

Abstract

Background: Status epilepticus is one of the most commonly occuring emergencies among children across the world. Time is crucial in the treatment of SE, with increasing risk of long term adverse events and sequelae with delay in treatment or action of drugs. This systematic review and meta-analysis aims to compare levetiracetam, a drug known for its comparatively safer profile, with other routinely used drugs in pediatric SE like phenytoin, fosphenytoin and valproate.

Methods: A comprehensive literature search was conducted across four databases from 1996 till November 2024. All original studies evaluating the efficacy of levetiracetam vis-a-vis other anti-seizure medications in pediatric children in an emergency setting were included in the study. Data analysis was conducted using RevMan software, using a random-effects model.

Results: A total of fourteen studies, comprising a patient population of 2,473, were included for further quantitative analysis. No differences were noted between the drugs when comparing seizure termination and recurrence at 24 h. Levetiracetam notably reduced the time to cessation of seizures when compared to phenytoin or fosphenytoin (MD=-3.97, 5% CI [-6.18, -1.76], p = 0.0004) and length of ICU stay over phenytoin (MD = 0.77, 95% CI [0.54, 1.00], p < 0.00001). A lower risk of adverse events was noted on use of levetiracetam over fosphenytoin (RR = 0.62, 95% CI [0.40, 0.96], p = 0.03); however risk of agitation was the least on use of phenytoin (RR = 3.90, 95% CI [1.42, 10.73], p = 0.008). Non significant differences in mortality rates were observed.

Conclusion: The study concludes better immediate effects of levetiracetam such as faster cessation of seizures. Levetiracetam was also suggested to stabilize patients faster, as implied by the lesser ICU stay and lower risk of adverse events. Further studies are needed to evaluate the efficacy of levetiracetam over other anti-seizure medications.

Keywords: Emergency department; Epilepsy; Levetiracetam; Pediatric; Phenytoin; Valproate.

Fig. 1

PRISMA flow diagram

Fig. 2

A Forest plot of different comparators for seizure termination rate, 24 h. B Forest plot of different study designs for seizure termination rate, 24 h

Fig. 3

A Forest plot of different comparators for ICU admission. B Forest plot of different study designs for ICU admission

Fig. 4

A Forest plot of 24 h seizure recurrence. B Forest plot of time of cessation, doses

Fig. 5

A Forest plot of Number of Adverse Events. B Forest plot of Mortality