University of Minnesota Study Finds Three Anti-seizure Drugs Equally Effective for Severe Form of Epilepsy

MINNEAPOLIS, MN- July 20, 2020 – There are three treatment options commonly used by doctors in the emergency room to treat patients with refractory status epilepticus, severe seizures that continue even after benzodiazepine medications.

Findings published in the New England Journal of Medicine reveal that three drugs, levetiracetam, fosphenytoin and valproate, are equally safe and effective in treating patients with refractory status epilepticus. 

The Established Status Epilepticus Treatment Trial (ESETT) began in 2013, enrolling more than 400 patients nationally, including 22 patients in the Twin Cities area at M Health Fairview University of Minnesota Medical Center, M Health Fairview University of Minnesota Masonic Children’s Hospital, M Health Fairview Southdale Hospital, Regions Hospital and Hennepin County Medical Center. The University of Minnesota hub is being led by Michelle Biros, MD, MS, FACEP, research director for the Department of Emergency Medicine at the University of Minnesota Medical School. 

Status epilepticus is a medical emergency defined as a continuous seizure lasting more than 30 minutes or two or more seizures without full recovery of consciousness between any of them. If not treated, it can lead to severe brain damage or death. Benzodiazepines are the first line of treatment for status epilepticus and are effective in two-thirds of patients. Refractory status epilepticus occurs in those patients in whom benzodiazepines do not stop their seizures. 

The study, supported by the National Institute of Neurological Disorders and Stroke, wanted to determine which of the anticonvulsant drugs was most effective in stopping seizures and improving a patient’s level of responsiveness within 60 minutes of administering treatment.

“It was a little question–what is the best treatment that the emergency department (ED) can use when a patient has failed all of the first-line drugs for seizures?” Biros said. “We have three drugs. The use of these drugs as a head-to-head comparison has never been done before, and the use of them in the ED has always been at the discretion of the doctor.” 

The study found all three drugs stopped seizures and improved responsiveness in approximately half of the study participants. There were no differences in serious side effects among the drugs. The results of ESETT validate the use of the three drugs and give emergency physicians options when it comes to treating patients with refractory status epilepticus. 

“From an emergency perspective, it kind of looked like a negative study because there wasn’t one winner, but it actually was good for emergency physicians because now they can use the drug they understand the best,” Biros said. 

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Kelly Glynn
Media Relations Coordinator, University of Minnesota Medical School