Name: Comparison of emergency department weight based levetiracetam dosing in patients with status epilepticus
Start: 2025-04-25T11:00:00-0400
End: 2025-04-25T11:15:00-0400

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Friday April 25, 2025 11:00am - 11:15am EDT

Athena G

Title: Comparison of emergency department weight based levetiracetam dosing in patients with status epilepticus
Authors: Zackery Moreo, Kelly Bodine, Olivia Morgan, John Patka
Objective: Evaluate impact of levetiracetam dosing in the ED on need for subsequent antiseizure medications (ASMs)
Self-Assessment Question: What is the optimal dose of levetiracetam in patients with SE?
Background: Status epilepticus (SE) is defined as a seizure with five minutes or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures. SE is a neurological emergency requiring immediate evaluation and management to prevent significant morbidity and mortality. Benzodiazepines are first line treatment for aborting seizure activity; however, in SE seizures may be refractory requiring second line treatment options. Guidelines for SE recommend the use of levetiracetam as a second line agent but, the dosing recommendations for levetiracetam vary. Other available studies have compared the use of levetiracetam at various doses to other antiseizure medications (ASMs), but few have compared the efficacy of different levetiracetam dosing strategies to each other. Due to this and the variation in guideline recommendations, dosing throughout the emergency department (ED) may differ.
Methods: This was a retrospective cohort study of adult patients presenting to the ED with SE and received at least one dose of levetiracetam from January 2023 to December 2023. The primary outcome was percentage of patients requiring subsequent ASM’s 6-hours from initial levetiracetam dose. Secondary outcomes included the percentage of patients receiving guideline recommended dose of benzodiazepines, use of institutional order set, escalation of care (ICU admission or intubation). Primary and secondary outcomes were assessed utilizing Chi-Square analysis.
Results: A total of 300 patients were screened, 253 patients met inclusion criteria and were included in the final analysis. There was a total of 145 patients in the levetiracetam ≥ 60 mg/kg group and 108 patients in the levetiracetam < 60 mg/kg group. Patients had median age of 60, majority were male (56.6%) and black (82%). Patients had a mean weight of 73.1 kg (±18.2) in ≥ 60 mg/kg group and 80.1 kg (±22.6) in the < 60 mg/kg group. Ninety-seven patients (66.9%) in the ≥ 60mg/kg group had a history of epilepsy and 96 (66.2%) were prescribed ASM prior to admission, and 62 (57.4

Presenters

Zack Moreo

PGY-1 Pharmacy Resident, Grady Memorial Hospital

I was born and raised in Los Angeles California. I attended UNC at Chapel Hill for Pharmacy School and I'm a current PGY-1 pharmacy resident at Grady Memorial Hospital. I'm staying on next year to complete a PGY-2 in Emergency Medicine.

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