New epileptic seizure treatment for kids to impact globally

The number of children undergoing a severe epileptic seizure that need to be ventilated and sent to intensive care is about to halve, thanks to a new, more effective means of treating the condition in hospital.

The treatment, identified as part of a major study, also significantly improves the success rate in stopping the seizure and is expected to change management of the condition internationally. 

The study was conducted by the PREDICT research network in 13 emergency departments at hospitals in Aotearoa, New Zealand and Australia, and involved 233 child patients aged between three months and 16 years. 

Revisiting traditional treatment

In severe seizures, the first line of treatment (benzodiazepines) only stops the seizures in 40–60% of patients. Before this study, the second-line treatment was the anti-convulsant drug phenytoin, but until now this practice had never been scrutinised in a robust, major randomised controlled trial. Also, phenytoin was known to have a number of serious complications.

In this study, researchers compared phenytoin with newer anti-convulsant levetiracetam for the second-line treatment of seizures. Levetiracetam is used routinely as a daily medication to prevent seizures, but has not been properly tested against phenytoin for treatment of severe prolonged seizures.

The researchers found that when given individually, the drugs are as good as each other: both had a moderate success rate (50–60%) at stopping a prolonged seizure. But strikingly, treatment with one drug and then the other increased the success rate of stopping a seizure to approximately 75%.

Previously, children who continued seizing after phenytoin then needed to be intubated, sedated and placed on a ventilator in intensive care. By giving these two edications one after the other, researchers have potentially halved the number of children ventilated and sent to intensive care.

“This study has now given us robust evidence to manage children with prolonged seizures without reverting to intubation and intensive care,” said Dr Stuart Dalziel, who is Professor of Emergency Medicine and Paediatrics in the Departments of Surgery and Paediatrics at the University of Auckland and a paediatric emergency medicine specialist at Auckland’s Starship Children’s Hospital.

“By controlling seizures in the emergency department, we will increase the chance of these children recovering more quickly and returning back to their normal lives,” he said. “This research has already changed practice and led to new guidelines in New Zealand and Australia.”

“This study is going to profoundly improve treatment for children who are critically ill with epilepsy around the world,” said Professor Franz Babl, who is also Professor of Paediatric Emergency Medicine at the University of Melbourne.

The study has been published in medical journal The Lancet.

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