Abstract

Background: Primary: To compare the rates of clinical seizure cessation at 15 min after
intravenous bolus infusion in the two groups (valproate versus levetiracetam) of
children aged 1-12 years with refractory status epilepticus (uncontrolled with initial
BDZ and phenytoin bolus).
Materials and Methods: This study was conducted in Department of Pediatrics,
Mamata medical college and General hospital Khammam. Study Period: Oct 2017 to
Sept 2019. Study population: Children between 1 to 12 years with status epilepticus who
had received diazepam followed by phenytoin infusion of 20 mg/kg and repeat 10
mg/kg. If status was still not controlled, they were labelled as refractory status
epilepticus and enrolled in study. It was a Randomised controlled study.During the
study period(Oct 2017to Sept 2019) a total of 1835 children visited emergency room, at
our centre. Among them 259 children had seizures presenting feature. Fifty-seven
children met the criteria for enrolment. Seven of these children could not be
randomized. The remaining fifty children were randomized into two groups- group A
received valproate (n=25) and group B received levetiracetam (n=25).
Results: The mean age of the patients was 45± 34 months and there was male
preponderance (64%) seen in our study. The most common underlying etiology in both
groups was acute central nervous system infections including meningoencephalitis and
meningitis (40% in levetiracetam group and 64% in valproate group) Most children
came with first time seizures and only few(20%) were known cases of epilepsy and on
antiepileptics. Most of our children (56%) presented with generalised tonic clonic
seizures. Duration of status before admission was different in both groups with median
of 20 min and 30 min in levetiracetam and valproate group respectively and 40 % of
patients had received some treatment for seizure before reaching us.
Conclusion: In this study no significant differences were observed between intra venous
valproate and intra venous levetiracetam, in acute seizure control in children with SE
refractory to Benzodiazepam and Phenytoin. Both the drugs were effective in more than
2/3rd of the children. Perhaps this might justify the use of a new protocol for
management of refractory status epilepticus where in intravenous valproate or
levetiracetam could be included before use of benzodiazepine or thiopentol infusion