Intravenöses Levetiracetam zur Therapie des Status epilepticus –Eine retrospektive Erhebung

Status epilepticus (SE) is one of the most common neurological emergencies. It is associated with high morbidity and a mortality rate of 16-26%. Treatment needs to be early and efficient, but the medical treatment of SE often fails and has many side effects and contraindications. Firstline medicaments in the treatment of SE are benzodiazepines and phenytoine, but also valproate and barbiturates are used. However treatment with this medication is often ineffective. In addition there are many contraindications and possible side effcts to consider, especially in elderly with comorbidities and comedications. Examples for contraindications are arrhythmia for phenytoine, liverdamage for valproate and cardiovascular instability for barbiturates. Since the year 2000 levetiracetam is approved as an oral anticonvulsive drug. In oral application it proved to have low side effects and few interactions. Unwanted side effects are mainly dizziness, fatigue and changes in mood, especially aggressiveness. As the first of the newer anticonvulsive drugs, since 2006 it is also available for intravenous application. It has been approved for cases in which oral application is not possible . In this study there was retrospectively collected data over a period of time of 18 months. Included were all patients who received intravenous levetiracetam within an individual curative effort. While collecting data there was special attention on effectiveness of the medicament and the occurence of adverse events. In total there were included 19 cases in 17 different patients. The analysis of the data showed, that the underlying seizure was focal in all 19 episodes. Four times with secondary generalisation, three times as a non-convulsive SE. In eight cases the diagnosis of epilepsy was already known, in eleven patients it was the first incidence. Causes of the SE were on the one hand longterme diseases like intracranial tumors or former bleedings, on the other hand acute incidents like metabolic imbalance or hemorrhagic or ischemic stroke. In five cases the reason of SE remained unknown. In all episodes the SE was refractory to benzodiazepines. In seven cases also the application of another anticonvulsive drug than levetiracetam was ineffective. In total 17 of 19 cases of SE could be ceased by the application of intravenous levetiracetam. In two cases further medication had to be added. 44 Severe adverse events caused by the medicament or its form of application have not been observed. Observed side effects were mainly mood changes, two patients died due to their underlying diseases. At the time of this study there was no publication about a series of cases regarding this issue. The studies with similar design published later, showed similar results. It is also worth mentioning that in all studies focal and generalised as well as nonkonvulsive SE were effectively treated with intravenous levetiracetam. This underlines the importance of this medicament as a “broad-spectrum” anticonvulsive drug. The present study confirms the assumption that levetiracetam could be a safe and effective medicament in refractory status epilepticus. The significance of the study however is limited especially due to its retrospective design as well as the small group of patients and a large prospective randomised study is warranted to explore effectiveness and longterm tolerance.