COMPARISON BETWEEN EFFICACY OF INTRAVENOUS LEVETIRACETAM AND SODIUM VALPROATE IN PEDIATRIC PATIENTS WITH CONVULSIVE STATUS EPILEPTICUS IN EMERGENCY SETTING

Abstract

Background: Convulsive Status Epilepticus (CSE) is a pediatric neurological emergency associated with high morbidity and potential mortality if not promptly treated. While sodium valproate and levetiracetam are commonly used second-line antiepileptic drugs (AEDs), their comparative efficacy and safety in emergency pediatric settings remain under investigation. Objective: To compare the efficacy and safety of intravenous levetiracetam versus sodium valproate in the management of pediatric patients presenting with convulsive status epilepticus. Methods: This prospective, randomized controlled clinical trial was conducted over six months in the Pediatric Emergency Department of Lahore General Hospital, Lahore. A total of 110 children aged 2–12 years, who failed to respond to two doses of IV diazepam, were enrolled through non-probability consecutive sampling. Patients were randomized to receive either IV levetiracetam (30 mg/kg) or IV sodium valproate (20 mg/kg). Data were collected on seizure termination at 15 minutes, time to seizure cessation, total seizure duration, recurrence within 24 hours, and adverse events. Results: Seizure termination within 15 minutes occurred in 75% of the levetiracetam group and 80% of the valproate group (p=0.47). There were no significant differences in mean time to seizure cessation (5.8 ± 2.1 min vs. 6.2 ± 2.3 min) or total seizure duration (18.5 ± 7.4 min vs. 19.3 ± 6.9 min). Adverse events including hypotension, hepatotoxicity, and thrombocytopenia were more frequently observed in the valproate group, although differences were not statistically significant. Levetiracetam was associated with fewer complications and additional interventions. Conclusion: Both levetiracetam and sodium valproate demonstrated comparable efficacy in acute seizure control among pediatric CSE patients. However, levetiracetam showed a more favorable safety profile, suggesting it may serve as a safer and equally effective alternative in emergency pediatric seizure management. Further multicenter studies are recommended to validate these findings and assess long-term outcomes.

Keywords: Convulsive status epilepticus; levetiracetam; sodium valproate; pediatric emergency; antiepileptic drugs.