HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH REGISTER		Author Keyword(s) Vol Page [Advanced]

To: Journal of PRACTICAL NEUROLOGY Letters

Electronic Letters to:

Short reports: S Knake, J Gruener, K Hattemer, K M Klein, S Bauer, W H Oertel, H M Hamer, and F Rosenow Intravenous levetiracetam in the treatment of benzodiazepine refractory status epilepticus J Neurol Neurosurg Psychiatry 2008; 79: 588-589 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Intravenous levetiracetam for benzodiazepine refractory status epilepticus

Susanne Knake, Judith Gruener, Katja Hattemer, Karl M Klein, Sebastian Bauer, Wolfgang H. Oertel, Hajo M. Hamer, and Felix Rosenow   (30 April 2008)

Intravenous levetiracetam for benzodiazepine refractory status epilepticus

Nitin K Sethi, Prahlad K.Sethi, Josh Torgovnick, and Edward Arsura   (22 April 2008)

Intravenous levetiracetam for benzodiazepine refractory status epilepticus 30 April 2008
Susanne Knake, Neurologist Philipps-University Marburg, Judith Gruener, Katja Hattemer, Karl M Klein, Sebastian Bauer, Wolfgang H. Oertel, Hajo M. Hamer, and Felix Rosenow Send letter to journal: Re: Intravenous levetiracetam for benzodiazepine refractory status epilepticus knake{at}staff.uni-marburg.de Susanne Knake, et al.	Dear Editor, Dear Dr. Sethi, Thank you very much for sending the eLetter regarding our retrospective case "benzodiazepine refractory status epilepticus". We agree, that standard protocols should be used as the rule as long as levetiracetam is not approved for the treatment of status epilepticus (SE) and as long as there is no prospective randomized study demonstrating the efficacy of levetiracetam in SE. In the patients reported, usually a concomitant disease (such as liver failiure etc.) guided us away from using phenytoin or phenobarbitol (see table 1 in the article). As all patients received at least one other antiepileptic drug, we cannot conclude if one antiepileptic drug or their combination was effective. This point was discussed in the paper. However, we thought it might be important to share our clinical experience with those who may experience similar situations in clinical practice and we hope that our results will spur interest in the conduction of a large, prospective trial. Susanne Knake
Intravenous levetiracetam for benzodiazepine refractory status epilepticus 22 April 2008
Nitin K Sethi, MD Comprehensive Epilepsy Center, NYP-Weill Cornell Medical Center, New York, NY (U.S.A.), Prahlad K.Sethi, Josh Torgovnick, and Edward Arsura Send letter to journal: Re: Intravenous levetiracetam for benzodiazepine refractory status epilepticus sethinitinmd{at}hotmail.com Nitin K Sethi, et al.	Dear Editor We read with interest the study by Knake et al. in which they investigated the efficacy and safety of intravenous levetiracetam (ivLEV) for the treatment of status epilepticus 1. Off label usage of LEV is exceedingly common and we would like to commend the authors for providing some data about the efficacy of iv LEV in the treatment of benzodiazepine refractory status epilepticus. All the patients in the study received at least a benzodiazepine before ivLEV was given and in 16 episodes ivLEV was he last drug to be administered. While ivLEV appears to be an attractive armament in the treatment of status epilepticus due to its favorable side effect profile, data with respect to its speed of action in aborting the status is not provided. It is possible that by chance a subgroup of patients in this study had status epilepticus that was relatively easy to control and would have got aborted irrespective of the drug used after the initial benzodiazepine infusion. In few of the other patients reported ivLEV was administered when valproic acid, phenytoin (patient No 15 a) or midazolam (patient No 12) failed to abort the status. Could it be possible that LEV was effective due to the fact that it was either co administered or administered soon after these frontal line status epilepticus drugs? Till further information is available on these issues it may be wise to adhere to the conventional status epilepticus abatement protocol of benzodiazepine -->phenytoin-->phenobarbital followed by either midazolam, propofol or pentobarbital infusion for status epilepticus refractory to benzodiazepine. Nitin K. Sethi, Prahlad K. Sethi, Josh Torgovnick, Edward Arsura The authors report no competing interests. References 1. Knake S, GruenerJ, Hattemer K, Klein KM, Bauer S, Oertel WH, Hamer HM, Rosenow E. Intravenous levetiracetam in the treatment of benzodiazepine refractory status epilepticus. J Neurol Neurosurg Psychiatry. 2008; 79:588-589.