SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Epilepsy
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1580329
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 Running Head: Levetiracetam vs Phenytoin/Fosphenytoin for CSE
Provisionally accepted
- Tianxiang Medical Oriental Hospital, Yiwu, China
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Objective: To compare the efficacy and safety of levetiracetam versus phenytoin/fosphenytoin as second-line treatments in children with convulsive status epilepticus (CSE).Methods: A systematic search identified randomized controlled trials comparing levetiracetam with phenytoin/fosphenytoin to treat CSE in children. Fourteen studies involving 2197 patients were included in the meta-analysis.Results: No 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.Levetiracetam is as effective as phenytoin/fosphenytoin to control seizures in children with CSE and is associated with fewer seizure recurrences and adverse events.
Keywords: Convulsive status epilepticus, Phenytoin, Fosphenytoin, levetiracetam, seizure, review, Meta-analysis
Received: 20 Feb 2025; Accepted: 05 May 2025.
Copyright: © 2025 Jin, Jin and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Linping Jin, Tianxiang Medical Oriental Hospital, Yiwu, China
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