September 2017

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Derek I., M.D. -

Great episode as always but I am concerned about some of the doses that you mentioned in your summary. As you alluded to, seizures have a kindling effect: they longer they go on, the more difficulty it is to stop the seizures. Specifically

The correct dose of levetiracetam is not 20 mg/kg but 60 mg/kg to maximum of 4500mg.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749120/

The correct dosing of valproic acid in status epilepticus is 40mg/kg to maximum dose of 3000mg.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749120/

There is a current multicenter trial examining the optimal 2nd line agent: Levetiracetam v. valproate v. fosphenytoin for status epilepticus

https://clinicaltrials.gov/ct2/show/NCT01960075

Would be happy to talk to you more about this subject as this is one of my interests.

Derek Isenberg, MD, FAAEM
Temple University
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Seizures in Pediatric Patients Full episode audio for MD edition 67:58 min - 94 MB - M4AC3 - 2017 - September Seizures in Pediatric Patients - Board Review Answers 177 KB - PDFC3 - 2017 - September Seizures in Pediatric Patients - Board Review Questions 132 KB - PDFC3 - Seizures in Pediatric Patients - MP3s 90 MB - ZIPC3 - Seizures in Pediatric Patients - Written Summary 533 KB - PDF

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