Objective: To review the literature evaluating the efficacy of
phenytoin monotherapy in adults with nonrefractory
status epilepticus. Data Sources: Articles were selected through a search of MEDLINE/PubMed (1966 to August 2014), using the terms
phenytoin and
status epilepticus. A further review of reference citations was performed to identify other relevant articles. Study Selection and Data Extraction: English-language case reports and clinical studies were reviewed. Publications evaluating the efficacy of
phenytoin monotherapy primarily in adults with nonrefractory
status epilepticus were included in the review. Two case studies and 5 clinical studies met the criteria. Data Synthesis: The ultimate goal for
status epilepticus treatment is seizure cessation.
Phenytoin, a venerable and oft-utilized
antiepileptic, has been employed in first-line and second-line regimens for
status epilepticus. Unfortunately, despite decades of use, data on the efficacy of
phenytoin monotherapy in these nonrefractory cases have been limited. The available studies are quite heterogeneous in design, with variable underlying etiologies of
status epilepticus, doses of study drugs, and comparators. Additionally, most are underpowered. When administered as second-line
therapy,
phenytoin monotherapy is comparable to
valproic acid in abating
status epilepticus. As first-line
therapy,
phenytoin monotherapy was inferior to
lorazepam but not
diazepam when used in combination with
phenytoin or
phenobarbital. Two other studies comparing
phenytoin with
valproic acid as first-line
therapy had conflicting results. Conclusions: In adults with nonrefractory
status epilepticus,
phenytoin monotherapy is a viable option for second-line
therapy. The data do not consistently support
phenytoin monotherapy's use as first-line treatment. More robust and adequately powered clinical studies are needed to assess whether these results remain consistent and extend to more long-term efficacy measures, such as morbidity and mortality.