The goal of this retrospective study was to compare the efficacy of levetiracetam re-bolus versus loading of an alternative anti-seizure drug (ASD) in Neuro ICU patients with non-convulsive seizures (NCS) or non-convulsive status epilepticus (NCSE) currently receiving seizure prophylaxis with levetiracetam.

NCSE/NCS are predictors of functional outcomes in Neuro ICU patients. Seizure burden and delay to treatment have been correlated with increased mortality.

Retrospective review of medical records and continuous EEG reports of adults admitted to the Duke University Hospital Neuro ICU between 01/01/2013-06/18/2018 returned 70 patients who either received a re-bolus of levetiracetam (group LEV) or were loaded with an alternative non-sedating ASD (group AASD) when NCS/NCSE was detected.  The primary outcome was mean time to seizure cessation.  Favorable disposition was defined as discharge to home or rehab and unfavorable disposition was defined as death or discharge to any other location.

Exploratory analyses revealed no difference in mean time to seizure cessation (33.94hr vs.  55.66hr, p=0.196), mean number of ASDs (2.35 vs 1.64, p=0.177), or rate of administration of IV anesthetics (12% vs. 45%, p=0.0982), for the patients in group LEV (n=17) compared with group AASD (n=53), respectively. Rate of favorable discharge disposition was similar (41% vs. 23%, p=0.141).  The group AASD was more likely to be intubated during their hospital stay (OR=3.13, p=0.047), however the hospital length of stay was similar between groups (23.9d for group LEV vs. 19.9d for group AASD, p=0.655).

The practice of levetiracetam re-bolus vs alternate non-sedating ASD loading appears to have no effect on mean time to seizure cessation for Neuro ICU patients who develop NCSE/NCS while receiving levetiracetam for seizure prophylaxis.