Levetiracetam Fosphenytoin

A 4-year-old previously healthy girl presented with new-onset seizures associated with fevers, headache, and malaise. She developed status epilepticus resistant to intravenous tenzodiaz-epines, fosphenytoin, levetiracetam, valproate, pentobarbital, and ketamine. An initial MRI brain scan was unremarkable. Isoflurane was begun, and an MRI scan 14 days later showed hyperintense T2 signals in the cerebellar vermis and cerebellar hemispheres. The isoflurane concentration was reduced to 0.5% and a further scan after 31 days of isoflurane therapy showed improvement in the signal abnormalities. Her isoflurane exposure was 1382% concentration-hours/1257 MAC-hours. She remained minimally conscious. 

Kassab MY, Lobeck IN, Majid A, Xie Y. Farooq MU Blood pressure changes after intravenous fosphenytoin and levetiracetam in patients with acute cerebral symptoms. Epilepsy Res 2009 87(2-3) 268-71. 

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