Levetiracetam Efficacy and Administration

Clinical Efficacy Data

• Each 1000 mg increase in dose raises odds of response by 40% 1
• 500 mg/day is NOT more effective than placebo 2

Position in Treatment Algorithm

• For established status epilepticus, administer 30 mg/kg IV over 5 minutes after benzodiazepines fail, with a success rate of 68-73% for benzodiazepine-refractory seizures, and minimal cardiovascular effects 1
• The American Academy of Neurology recommends levetiracetam as a second-line agent for status epilepticus, with a success rate of 68-73% for benzodiazepine-refractory seizures 1

Adverse Effects Profile

• Behavioral changes occur in 23% of children, and the Cornell Assessment of Pediatric Delirium (CAPD) tool should be used for monitoring, with consideration of prophylactic use in children with CNS disease or seizure history receiving CAR T-cell therapy 3

Comparative Effectiveness

• Levetiracetam 30 mg/kg has 68-73% efficacy, with 0% hypotension, compared to valproate, fosphenytoin, and phenobarbital, which have varying efficacy and side effect profiles 1
• The Neurocritical Care Society recommends considering levetiracetam as a second-line agent for status epilepticus, due to its efficacy and minimal cardiovascular effects 1