This double-blinded RCT, the only one of its kind, was published after the most recent guidelines had been finalized, and it has persuaded me that levetiracetam is of no value as an adjunct to benzodiazepines in the management of status epilepticus. Instead, this trial suggests levetiracetam should be only ordered if the status has conclusively resolved before the clinician has had the chance to order the conventional AED. The regimen used in the trial was 2500 mg over 5 minutes – less than the ACEP guideline suggests, but at the upper end of the range of doses suggested in the older Neurocritical Care guideline, and certainly more than most clinicians use in practice.
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