If you’ve ever watched a patient, friend, or family member have a seizure, you know how scary and stressful it can be for everyone involved. It’s even more stressful when you can’t get the seizure to stop – this is called status epilepticus. Usually, benzodiazepines are our first line medication. If benzos don’t work, we all have our favorite second, and even third line agents to try to break seizures. But how well do they really work? Is one better than another? Or safer?
This episode starts with a personal story told by parents of a child who suffers from epilepsy. Then we welcome guest host, Dr. Jason Woods of the Little Big Med podcast, to help us answer these questions. Dr. Jim Chamberlain is the pediatric principal investigator for the ESETT trial, in which he and his colleagues studied three common second line anti epileptic medications. He shares some of the novel statistical methods they used and the results that were recently published in the New England Journal of Medicine. Then we speak with our own Dr. Daniel Nishijima, general EM physician and site Co-PI for the trial, about the implications for adults and how the results have (or have not?) changed his practice.
What are your favorite first and second line medications for status epilepticus? When do you decide to intubate? We’d love to hear how you practice. Connect with us on social media, @empulsepodcast, or at ucdavisem.com.
*** Registration is still open for the 43rd annual UC Davis Emergency Medicine Winter Conference, February 24th-29th at the Ritz Carlton in Lake Tahoe! ***
Dr. Julia Magaña, Assistant Professor of Pediatric Emergency Medicine at UC Davis
Dr. Sarah Medeiros, Assistant Professor of Emergency Medicine at UC Davis
Dr. Jim Chamberlain, Professor of Pediatrics and Emergency Medicine at George Washington University and Children’s National Hospital, Pediatric Principal Investigator for the ESETT trial
Dr. Daniel Nishijima, Associate Professor of Emergency Medicine at UC Davis, Site Co-Pricipal Investigator for the ESETT trial
Kapur J, Elm J, Chamberlain J, et al. Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus. N Engl J Med. 2019;381(22):2103-2113.
Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults: report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr 2016;16: 48–61.
Dalziel SR, Borland ML, Furyk J, et al. Levetiracetam versus phenytoin for second-line treatment of convulsive status epilepticus in children (ConSEPT): an open-label, multicentre, randomised controlled trial. Lancet 2019; published online April 17.
Lyttle MD, Rainford NEA, Gamble C, et al. Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE):
a multicentre, open-label, randomised trial. Lancet 2019; published online April 17.
Connor JT, Elm JJ, Broglio KR, ESETT and ADAPT-IT Investigators. Bayesian adaptive trials offer advantages in comparative effectiveness trials: an example in status epilepticus J Clin Epidemiol 2013;
Zaccara G, Giannasi G, Oggioni R, et al. Challenges in the treatment of convulsive status epilepticus. Seizure. 2017;47:17-24.
Ilvento L, Rosati A, Marini C, L’Erario M, Mirabile L, Guerrini R. Ketamine in refractory convulsive status epilepticus in children avoids endotracheal intubation. Epilepsy Behav. 2015;49:343-346.
Niquet J, Baldwin R, Norman K, Suchomelova L, Lumley L, Wasterlain C. Midazolam-ketamine dual therapy stops cholinergic status epilepticus and reduces Morris water maze deficits. Epilepsia. 2016;57(9):1406-1415.