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Preferential Antiseizure Medications in Pediatric Patients with Convulsive Status Epilepticus: A Systematic Review and Network Meta-Analysis

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Abstract

Background and Objective

The optimal choice for first- and second-line antiseizure medications for pediatric patients with convulsive status epilepticus remains ambiguous. The present study aimed to estimate the comparative effect on the efficacy and safety of different antiseizure medications in pediatric patients with status epilepticus and provide evidence for clinical practice.

Methods

We searched PubMed, EMBASE, and the Cochrane Library for eligible randomized controlled trials. Inclusion criteria included: (1) pediatric patients; (2) diagnosis of status epilepticus; and (3) randomized controlled trials. Exclusion criteria were: (1) mixed population without a pediatric subgroup analysis; (2) not status epilepticus; (3) received the study drug prior to admission; (4) sample size fewer than 30; and (5) not randomized controlled trials. Primary outcome was seizure cessation. Secondary outcomes were seizure recurrence within 24 h, respiratory depression, and admission to an intensive care unit. The hierarchy of competing antiseizure medications was presented using the surface under the cumulative ranking curve.

Results

Eight first-line antiseizure medication studies involving 1686 participants and eight second-line antiseizure medication studies involving 1711 participants were eligible for analysis. Midazolam, diazepam, lorazepam, and paraldehyde were administered as first-line antiseizure medications. Valproate, phenobarbital, phenytoin, fosphenytoin, and levetiracetam were investigated as second-line antiseizure medications. No significant differences were observed across first- and second-line antiseizure medications. Midazolam ranked the best for primary and secondary outcomes among the first-line antiseizure medications. Phenobarbital ranked the best for seizure cessation and a lower risk of admission to the intensive care unit. Valproate had superiority in preventing recurrence within 24 h. Levetiracetam had the lowest probability of develo** respiratory depression.

Conclusions

This study demonstrated the hierarchy of competing interventions. Midazolam could be a better option for first-line treatment. Phenobarbital, levetiracetam, and valproate had their respective superiority in the second-line intervention. This study may provide useful information for clinical decision making under different circumstances.

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Author information

Author notes

  1. Yihao Zhang and Yingjie Liu contributed to this manuscript equally.

Authors and Affiliations

  1. Department of Neurosurgery, **angya Hospital, Central South University, No.87 **angya Road, Changsha, 410008, Hunan, China

    Yihao Zhang & Zhixiong Liu

  2. Department of General Surgery, The Third **angya Hospital, Central South University, Changsha, China

    Yingjie Liu

  3. Department of Neurology, **angya Hospital, Central South University, Changsha, China

    Qiao Liao

Authors
  1. Yihao Zhang
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  2. Yingjie Liu
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  4. Zhixiong Liu
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Corresponding author

Correspondence to Zhixiong Liu.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

Yihao Zhang, Yingjie Liu, Qiao Liao, and Zhixiong Liu have no conflicts of interest that are directly relevant to the content of this article.

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Data availability

The data used in this study were fully available in databases.

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Author contributions

YZ and YL equally contributed to this manuscript in conception, data extraction, quality assessment, data analysis, and drafting. QL and ZL revised the manuscript.

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Zhang, Y., Liu, Y., Liao, Q. et al. Preferential Antiseizure Medications in Pediatric Patients with Convulsive Status Epilepticus: A Systematic Review and Network Meta-Analysis. Clin Drug Investig 41, 1–17 (2021). https://doi.org/10.1007/s40261-020-00975-7

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