Researchers found that the drugs Levetiracetam and Phenytoin, when used one after another increased the success rate of stopping a seizure to approximately 75%

Emergency medicine doctors now have a better way to treat severe epileptic seizures in children, thanks to a study conducted in New Zealand and Australia.

Prolonged epileptic seizures are the most common neurological emergency in children seen by hospitals. The seizures are potentially fatal: up to 5% of affected children die, and a third suffer long-term complications from brain damage. Crucially, the longer the seizure, the greater the chance of long-term complications.

The study—which will change management of this condition internationally—was published in the medical journal The Lancet this week. It was led by professor Stuart Dalziel from the Faculty of Medical and Health Sciences at the University of Auckland and Starship Children's Hospital, and the senior author was professor Franz Babl at Melbourne's Murdoch Children's Research Institute.

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

In this world-leading study, funded by the Health Research Council of New Zealand, 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 research, conducted by the PREDICT research network in 13 emergency departments at hospitals in New Zealand and Australia, involved 233 pediatric patients aged between 3 months and 16 years.

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 medications 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," says Dr. Dalziel, who is professor of emergency medicine and pediatrics in the Departments of Surgery and Paediatrics, and a pediatric 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 says. "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," says professor Franz Babl, who is also professor of pediatric emergency medicine at the University of Melbourne.