The anticonvulsant medication phenytoin has been used as the usual second-line treatment of CSE for several decades and is known to have rare but potentially dangerous side effects. However, some evidence suggests that another medication, levetiracetam, could be an effective and safer alternative.

A new study published in The Lancet, involving researchers from the University of Liverpool and Alder Hey Children's Hospital Trust, has identified a "user friendly" treatment for the most common life-threatening neurological emergency in children.

Every day in the United Kingdom, 87 people are diagnosed with epilepsy, affecting over 600,000 people. Many people with a new diagnosis of epilepsy will experience memory and other cognitive problems. The cause of these problems is unknown. It has an annual incidence of 20 per 100,000 children, and is the second most common reason for unplanned admissions to paediatric intensive care units (PICUs) in the United Kingdom.

Anti-epileptic drugs (AEDs), also known as anticonvulsants, are used to control seizures in people with epilepsy. Convulsive status epilepticus (CSE) is the situation when a tonic-clonic seizure doesn't stop either on its own or with anticonvulsants. It is the most common life-threatening neurological emergency in children.

Currently, CSE is treated using an algorithm which incorporates 10-minute intervals between treatments. Second-line treatment is given when CSE persists either after two doses of the first-line treatment, which is an anticonvulsant called a benzodiazepine, or the child's personalized emergency (rescue) treatment.

The anticonvulsant medication phenytoin has been used as the usual second-line treatment of CSE for several decades and is known to have rare but potentially dangerous side effects. However, some evidence suggests that another medication, levetiracetam, could be an effective and safer alternative. To ascertain which treatment was safest and most effective, the EcLiPSE Team, made up of doctors from Alder Hey and Bristol Children's Hospitals together with research teams from the Universities of Liverpool and the West of England, conducted a trial to compare the efficacy and safety of both drugs for second-line management of CSE.

The EcLiPSE Team is led by professor Richard Appleton, a Merseyside pediatric neurologist based at the University of Liverpool's Department of Women's and Children's Health and Alder Hey Children's Hospital Trust.

Between 2014 and 2018 the team conducted a randomized, clinical trial involving 30 UK emergency departments and almost 300 children. The results did not show that levetiracetam was better than phenytoin in stopping CSE. However, overall, the results suggest levetiracetam may be considered as an alternative treatment to phenytoin.

Appleton said, "The EcLiPSE trial has given doctors new and unique evidence for the choice of anticonvulsant and how to best treat this childhood neurological emergency. Our results suggest that levetiracetam could be considered as an alternative treatment to phenytoin for second-line management of pediatric CSE. Possible benefits of levetiracetam over phenytoin include its ease of preparation and administration, minimal interaction with antiepilepsy and other drugs, and easy conversion to oral maintenance therapy. Further randomized clinical trial and meta-analysis data could help to confirm our results and might lead to levetiracetam being the preferred second-line anticonvulsant in children with benzodiazepine-resistant convulsive status epilepticus. The trial also highlights the importance of close and effective collaboration between two specialities in pediatrics, neurology and emergency medicine, that will improve the care of children with epilepsy."