ESETT – EM PharmD Podcast Episode 2

ESETT: A response-adaptive comparative effectiveness study of patients with generalized convulsive seizures not responding to initial benzos at 57 hospital emergency departments across the United States. 


After sub-optimal but real-world relevant benzodiazepine dose patients who were still seizing were randomized to receive:

Levetiracetam 60 mg/kg (Up to 4500mg)

Valproate 40 mg/kg (Up to 3000mg)

Fosphenytoin 20 mg/kg (Up to 1500mg)


The primary outcome was the absence of clinically apparent seizures and improving responsiveness at 60 minutes after the start of the trial drug infusion, without additional anticonvulsant medication, including medication used for RSI


Results: No difference

Levetiracetam: 47%

Valproate: 46%

Fosphenytoin: 45%


Secondary and safety outcomes = no difference either


The authors concluded that fosphenytoin, valproate, and levetiracetam were effective in approximately half the patients with benzodiazepine-refractory status epilepticus, and they did not differ significantly with regard to effectiveness and safety.


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