Levetiracetam versus phenytoin/fosphenytoin for second-line treatment of children with convulsive status epilepticus: an up-to-date meta-analysis and systematic review of randomized controlled trials
ObjectiveTo compare the efficacy and safety of levetiracetam versus phenytoin/fosphenytoin as second-line treatments in children with convulsive status epilepticus (CSE).MethodsA systematic search identified randomized controlled trials comparing levetiracetam with phenytoin/fosphenytoin to treat CS...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1580329/full |
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| Summary: | ObjectiveTo compare the efficacy and safety of levetiracetam versus phenytoin/fosphenytoin as second-line treatments in children with convulsive status epilepticus (CSE).MethodsA systematic search identified randomized controlled trials comparing levetiracetam with phenytoin/fosphenytoin to treat CSE in children. Fourteen studies involving 2,197 patients were included in the meta-analysis.ResultsNo significant difference was found between the two treatments regarding seizure cessation (odds ratio (OR): 1.18, 95% confidence interval (CI): 0.94–1.48; p = 0.16) or time to clinical seizure termination (mean difference: −0.10, 95% CI: −0.61 to 0.40; p = 0.69). However, levetiracetam was associated with significantly fewer seizure recurrences (OR: 0.60, 95% CI: 0.43–0.84; p = 0.003) and adverse events (OR: 0.59, 95% CI: 0.37–0.94; p = 0.03) compared with phenytoin/fosphenytoin. No significant differences were observed in the need for mechanical ventilation, intensive care unit admission, or hospital length of stay.ConclusionLevetiracetam is as effective as phenytoin/fosphenytoin to control seizures in children with CSE and is associated with fewer seizure recurrences and adverse events. |
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| ISSN: | 1664-2295 |