Let's retire phenytoin! Levetiracetam as the first choice in the treatment of convulsive status epilepticus.

Status epilepticus (SE) is the most severe presentation of epilepsy. Most available data on the treatment of SE refers to the convulsive type. Treatment begins with an accurate diagnosis, followed by clinical stabilization and rapid administration of benzodiazepines (BZDs). Then, treatment continues with the use of an intravenous antiseizure medication (ASM). Phenytoin has been the preferred ASM as the second-line treatment of SE (after failure of BZDs to control seizures), although this choice was mostly guided by low-quality evidence. Recent evidence demonstrates that levetiracetam is at least as effective as phenytoin in the treatment of convulsive SE, both in adults and children. Moreover, growing evidence indicates that levetiracetam offers better tolerability and a more favorable safety profile. Therefore, in this Point of View, we argue that we should retire phenytoin in the treatment of convulsive SE, and levetiracetam should become the first choice of treatment.