Which is the optimum second-line therapy for adults and children with benzodiazepine-refractory convulsive status epilepticus?

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Why is this study important?

The most common paediatric neurological emergency in the world is convulsive status epilepticus and the recommended first-line treatment is a benzodiazepine.[1] However, for benzodiazepine-refractory status epilepticus (BRSE), the optimum therapy is unclear, and recommendations vary. This randomized controlled trial (RCT) compares the potential efficacy and safety of the second-line anticonvulsants levetiracetam, fosphenytoin, and valproate for the treatment of BRSE among children and adults in the emergency department (ED).

Which, if any, threats to validity are most likely to have an impact on the results and how?

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