From the Guidelines
Alternatives to benzodiazepines for seizure control include levetiracetam, fosphenytoin, and valproate. These medications have been shown to be effective in terminating seizures in patients with benzodiazepine-resistant status epilepticus, with approximately half of patients achieving seizure cessation 1.
Key Findings
- A study published in the Annals of Emergency Medicine found that levetiracetam, fosphenytoin, and valproate had similar efficacy in terminating seizures, with response rates of 47%, 45%, and 46%, respectively 1.
- Valproate has been shown to be at least as effective as phenytoin in controlling seizures, with potentially fewer adverse effects 1.
- Levetiracetam has been found to be effective in terminating seizures in patients with status epilepticus, with response rates ranging from 38% to 73% in different studies 1.
Medication Options
- Levetiracetam: can be administered at a dose of 30 mg/kg IV load delivered at 5 mg/kg per minute 1.
- Fosphenytoin: can be administered at a dose of 20 mg/kg IV load 1.
- Valproate: can be administered at a dose of 30 mg/kg IV load delivered at 5 mg/kg per minute 1.
Important Considerations
- The choice of medication should be based on individual patient factors, such as medical history and potential drug interactions.
- These medications should only be used under the guidance of a healthcare professional, as they can have potential side effects and interactions with other medications.
From the Research
Alternatives to Benzodiazepines for Seizure Control
- There are several alternatives to benzodiazepines for seizure control, including other antiepileptic drugs (AEDs) such as carbamazepine, phenytoin, valproate, and ethosuximide 2.
- For patients with absence status epilepticus, alternatives to benzodiazepines include ethosuximide or valproate 2.
- In cases of primary generalized epilepsies, valproate is often used as an alternative to benzodiazepines 2.
- For typical childhood absence seizures, ethosuximide is prescribed as an alternative to benzodiazepines 2.
Non-Benzodiazepine Options for Status Epilepticus
- Clonazepam is an effective alternative to lorazepam and midazolam for the treatment of status epilepticus 3.
- Clonazepam was associated with a lower risk of refractoriness and required fewer antiseizure drugs to control status epilepticus compared to lorazepam 3.
- Other non-benzodiazepine options for status epilepticus include phenytoin, which is often used in combination with benzodiazepines 2.
New Delivery Methods for Benzodiazepines
- Alternative delivery methods for benzodiazepines, such as intranasal diazepam or midazolam, and intramuscular auto-injector for midazolam, are being explored as alternatives to traditional routes of administration 4.
- These new delivery methods have shown to be as effective as rectal or intravenous diazepam in the acute treatment of seizures 4.