Optimizing Levetiracetam Dosage in Status Epilepticus

Objectives: Status epilepticus (SE) is a severe neurological condition with significant morbidity and mortality. While guidelines offer recommendations for emergent therapy with benzodiazepines, there is limited guidance for medications for urgent control in SE. High-dose levetiracetam (LEV) (60 mg/kg) was introduced in the 2019 ESETT trial and has not been studied against the previous standard. Methods: This retrospective cohort evaluated patients admitted for SE. Patients were included if they received ≥1 dose of intravenous LEV ≥20 mg/kg from January 1, 2019, to January 14, 2022, and were 17 years of age or older. Traumatic injuries were excluded. Patients were divided into groups of LEV loading dose of <40 mg/kg and LEV loading dose of ≥40 mg/kg. Results: Patients who received ≥40 mg/kg of LEV were less likely to require a second ASM within 48 hours as compared with those receiving <40 mg/kg 39(69.9%) vs. 15(38.5%); P =0.0127. After logistic regression analysis that included home ASM use, doses ≥40 mg/kg of LEV, and a total of ≥4 mg of lorazepam equivalents received, no difference was seen in ASM requirements. Patients who received <40 mg/kg were more likely to have a history of seizure and be on ASMs before admission. Conclusions: After logistic regression, the loading dose of LEV did not change the need for additional ASM to control seizures in SE. Further investigations evaluating the efficacy of 20 mg/kg compared with 60 mg/kg are needed; however, this study found no difference in seizure control between the groups.