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The three medications -- levetiracetam (Keppra and Roweepra), fosphenytoin (Cerebyx) and valproate -- are commonly used to treat patients with "refractory status epilepticus." In these patients, severe seizures continue after treatment with benzodiazepine medications.
The study of 380 emergency department patients compared the three drugs' effectiveness in stopping seizures and improving patients' levels of responsiveness within 60 minutes. The patients included children and adults.
The three treatments stopped seizures and improved responsiveness in about half of the patients: 47% in the levetiracetam group; 45% in the fosphenytoin group; and 46% in the valproate group. Researchers said the differences were not statistically significant.
The three drugs had no differences in serious side effects, according to the study published Nov. 28 in the New England Journal of Medicine.
The research was supported by the U.S. National Institute of Neurological Disorders and Stroke (NINDS), part of the National Institutes of Health.
"Doctors can be confident that the particular treatment they choose for their patients with status epilepticus is safe and effective, and may help them avoid the need to intubate the patient as well as stays in the intensive care unit," study co-author Dr. Robin Conwit, NINDS program director, said in an agency news release.
Study co-leader Dr. Robert Silbergleit said the study suggests that clinical outcomes are driven by factors other than drugs.
"Differences in how doctors decide to treat status epilepticus, such as when they give more drugs or when to anesthetize patients and put them on a mechanical ventilator, may be more important than the specific treatments used to control seizures in patients," said Silbergleit, a professor of emergency medicine at the University of Michigan in Ann Arbor.
In status epilepticus, seizures occur close together and last more than 5 minutes, with a loss of consciousness. If not treated, patients can suffer severe brain damage or die. Benzodiazepines are effective in two-thirds of patients.
-- Robert Preidt
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