The potential prehospital role of levetiracetam: a systematic review

Background: Status epilepticus is a life-threatening, time-critical emergency associated with substantial mortality. Current treatment delivered by paramedics is the administration of benzodiazepines and working in critical care teams that deliver prehospital emergency anaesthesia. In hospitals, second-line agents are used before anaesthesia. Levetiracetam is a pharmacologically stable agent suitable for the prehospital environment. Methods: A systematic review of the literature on the use of levetiracetam in terminating acute status epilepticus was carried out. Prehospital studies were limited so in-hospital papers from emergency settings were included. Results: Levetiracetam has overall efficacy of 71.9% (95% CI (66.3–77.5)), comparable to phenytoin and sodium valproate. It has fewer adverse events than other agents. Response was independent of dose administered but higher doses (>40 mg/kg) caused more side effects. Conclusions: Levetiracetam is a safe, effective medication in terminating status epilepticus and may reduce the need for prehospital emergency anaesthesia if used in prehospital management. More research should be done in the prehospital setting.