Second-line antiseizure drug helps with toxin-related seizure in status epilepticus patients

Some patients with benzodiazepine-refractory status epilepticus experience a toxin-related seizure, which can be successfully treated with a single dose of second-line antiseizure medication, according to a post hoc analysis of the Established Status Epilepticus Treatment Trial (ESETT).

ESETT included 249 adults and 229 children with benzodiazepine-refractory status epilepticus who received levetiracetam, valproate, or fosphenytoin as second-line agents. The primary endpoint was seizure freedom and improvement in the level of consciousness 1 hour after study drug administration.

In the current post hoc analysis, researchers assessed the safety and efficacy of the second-line agents in a subgroup of 29 (11.6 percent) adults and one (0.4 percent) child with toxin-related seizures.

Toxin-related seizures in adults were more likely to occur in men than in women (25 of 145, 17.2 percent vs 4 of 104, 3.9 percent). The most common toxin-related precipitants were alcohol withdrawal (37 percent) and cocaine (37 percent). Among the 11 cocaine users, 10 (91 percent) used other substances at the same time, with opioid being the most frequent.

For alcohol withdrawal–related seizures, treatment success rates were 100 percent (3 out of 3 patients) with levetiracetam, 50 percent (3 out of 6 patients) with valproate, and 50 percent (1 out of 2 patients) with fosphenytoin.

For cocaine-related seizures, treatment success rates were 14 percent (1 out of 7 patients) with levetiracetam, 0 percent (0 out of 1 patient) with valproate, and 33 percent (1 out of 3 patients) with fosphenytoin.

One patient who used cocaine and an opioid concomitantly and was treated with fosphenytoin developed life-threatening hypotension.