American journal of translational research · 2026
Efficacy and safety of levetiracetam intravenous infusion combined with midazolam continuous pump infusion for stepwise emergency treatment of convulsive status epilepticus in children: a retrospective cohort study.
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Zhang Yunchao, Liu Ya, Pan Nana, Yang Yancheng
Аннотация
OBJECTIVES: To evaluate the efficacy and safety of intravenous levetiracetam (LEV) combined with continuous midazolam (MDZ) infusion versus MDZ monotherapy as second-line treatment for pediatric convulsive status epilepticus (CSE).
METHODS: This retrospective cohort study included 159 pediatric patients with generalized convulsive status epilepticus (GCSE) treated between June 2017 and December 2025. Patients received either LEV+MDZ (n=86) or MDZ alone (n=73). Outcomes included seizure cessation at 20 and 40 minutes, 24-hour seizure control, requirement for third-line antiseizure medication, adverse events, change in Status Epilepticus Severity Score (STESS), lengths of pediatric intensive care unit (PICU), and Pediatric Cerebral Performance Category (PCPC) score at discharge.
RESULTS: Compared to MDZ monotherapy, the combination group showed significantly greater reduction in STESS at 24 hours (1.94 ± 0.46 vs. 2.67 ± 0.53, P < 0.001) and a lower requirement for third-line medication (11.63% vs. 24.66%, P=0.032). Midazolam cumulative dose at 1 hour was lower with combination therapy (0.28 ± 0.10 vs. 0.32 ± 0.11 mg/kg, P=0.013). Incidence of adverse events was similar between groups (16.28% vs. 21.92%, P=0.365). Furthermore, the combination group had shorter PICU stay (2.73 ± 1.28 vs. 3.42 ± 1.56 days, P=0.003), shorter total hospitalization (6.52 ± 2.01 vs. 7.85 ± 2.27 days, P < 0.001), and better PCPC scores at discharge (1.89 ± 0.71 vs. 2.32 ± 0.82, P < 0.001).
CONCLUSIONS: Early administration of LEV combined with MDZ was associated with reduced seizure severity, decreased need for rescue therapy, lower benzodiazepine exposure, shorter hospitalization, and improved short-term neurological outcome without increasing adverse events in pediatric patients with CSE.
METHODS: This retrospective cohort study included 159 pediatric patients with generalized convulsive status epilepticus (GCSE) treated between June 2017 and December 2025. Patients received either LEV+MDZ (n=86) or MDZ alone (n=73). Outcomes included seizure cessation at 20 and 40 minutes, 24-hour seizure control, requirement for third-line antiseizure medication, adverse events, change in Status Epilepticus Severity Score (STESS), lengths of pediatric intensive care unit (PICU), and Pediatric Cerebral Performance Category (PCPC) score at discharge.
RESULTS: Compared to MDZ monotherapy, the combination group showed significantly greater reduction in STESS at 24 hours (1.94 ± 0.46 vs. 2.67 ± 0.53, P < 0.001) and a lower requirement for third-line medication (11.63% vs. 24.66%, P=0.032). Midazolam cumulative dose at 1 hour was lower with combination therapy (0.28 ± 0.10 vs. 0.32 ± 0.11 mg/kg, P=0.013). Incidence of adverse events was similar between groups (16.28% vs. 21.92%, P=0.365). Furthermore, the combination group had shorter PICU stay (2.73 ± 1.28 vs. 3.42 ± 1.56 days, P=0.003), shorter total hospitalization (6.52 ± 2.01 vs. 7.85 ± 2.27 days, P < 0.001), and better PCPC scores at discharge (1.89 ± 0.71 vs. 2.32 ± 0.82, P < 0.001).
CONCLUSIONS: Early administration of LEV combined with MDZ was associated with reduced seizure severity, decreased need for rescue therapy, lower benzodiazepine exposure, shorter hospitalization, and improved short-term neurological outcome without increasing adverse events in pediatric patients with CSE.