This was a prehospital, randomized, double blind, placebo controlled trial of adults with convulsions lasting >5minutes comparing 2.5g (!) of levetiracetam (Keppra) or placebo in combination 1mg of clonazepam. If convulsions lasted another 5 minutes, another 1mg of clonazepam was given. The primary outcome was cessation of convulsions within 15 minutes of initial drug injection. The trial was stopped early due to no evidence of a treatment difference after an interim analysis showed no difference (68 patients in intent-to-treat analysis per arm). Convulsions were stopped at 15 minutes in 57/68 (84%) patients receiving clonazepam vs 50/68 (74%) of patients receiving levetiracetam.
This study was funded by UCB, who manufactures Keppra.
As someone who embraces aggressive treatment of status epilepticus (escalating benzos + early dilantin / keppra followed by early intubation if needed) – particularly with Keppra since it can be given relatively quickly – this makes me go back to the literature rethink my treatment algorithm.