fosphenytoin / Generic mfg. - LARVOL DELTA

Guidelines for Seizure Prophylaxis in Patients with Aneurysmal Subarachnoid Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society. (PubMed, Neurocrit Care) - "Overall, the quality of evidence is low, precluding strong recommendations. We suggest that ASM or no ASM may be used in patients hospitalized with aneurysmal subarachnoid hemorrhage (conditional recommendation, low quality of evidence). If used, we suggest either levetiracetam or phenytoin/fosphenytoin (conditional recommendation, very low quality of evidence) for a short or long duration (conditional recommendation, moderate quality of evidence)."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Hematological Disorders • Subarachnoid Hemorrhage

Epilepsy-Related Psychosis in Drug-Resistant Epilepsy With Nonconvulsive Status Epilepticus and Difficult Antipsychotic Titration: A Case Report. (PubMed, Neuropsychopharmacol Rep) - "This case emphasizes the need for a low threshold for EEG, structured diagnostic reasoning, and careful monitoring of pharmacokinetic interactions when treating psychosis in drug-resistant epilepsy."

Journal • Alzheimer's Disease • CNS Disorders • Cognitive Disorders • Dementia • Epilepsy • Lewy Body Disease • Metabolic Disorders • Movement Disorders • Psychiatry

Anti-seizure medications and DRESS in paediatric patients: A FAERS disproportionality and time-to-onset analysis. (PubMed, Br J Clin Pharmacol) - "Significant signals of DRESS associated with 13 ASMs were identified in paediatric populations. Notably, signals were detected for the first time for ethosuximide, perampanel, fosphenytoin and eslicarbazepine by disproportionality analysis. TTO analysis demonstrated wear-out or random failure-type patterns in the occurrence of ASM-associated DRESS."

Journal • CNS Disorders • Eosinophilia • Epilepsy • Pediatrics

Effective treatment for lithium pilocarpine-induced status epilepticus: clonazepam and lacosamide combination. (PubMed, Epilepsy Behav) - "This study aimed to investigate the potential of clonazepam (CLZ), one of the benzodiazepines used in the first-line treatment of status epilepticus, in combination with anti-seizure medications such as levetiracetam (LEV), lacosamide (LCM), valproic acid (VPA), and fosphenytoin (fPHT), which are used in second-line treatment, in polytherapy. A decrease in forced motor functions was observed in the CLZ + VPA and CLZ + fPHT groups compared to the control group (p < 0.01). In conclusion, CLZ alone and the CLZ-LEV combination were insufficient to prevent epileptiform activity associated with status epilepticus, whereas CLZ-based polytherapies -most notably CLZ-LCM, followed by CLZ-VPA and CLZ-fPHT- were more effective in reducing epileptiform spike frequency and amplitude."

Journal • CNS Disorders • Epilepsy • Mood Disorders • Psychiatry

Case Report: Intravenous fosphenytoin successfully treated acute exacerbation of secondary trigeminal neuralgia due to petroclival meningioma. (PubMed, Front Pain Res (Lausanne)) - "Despite escalation of carbamazepine (CBZ) and CyberKnife radiosurgery, she experienced a TN crisis, presenting with persistent severe pain and impaired oral intake...Because of symptom recurrence, fosphenytoin was continued at maintenance dose for seven days, in parallel with CBZ titration to 800 mg/day and addition of baclofen. Oral intake improved rapidly thereafter, and no further acute exacerbations were observed over three months of follow-up. This case highlights the potential of intravenous fosphenytoin as an effective and rapid treatment for acute crisis of secondary TN, especially when oral therapy is not feasible."

Journal • Brain Cancer • Meningioma • Neuralgia • Oncology • Pain • Solid Tumor

IV Fosphenytoin for Acute Trigeminal Neuralgia: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. (PubMed, Neurology) - "IFT provided rapid and well-tolerated pain relief in acute TN exacerbations. Although findings are preliminary because of the small sample size, IFT may be a viable short-term treatment option, meriting further investigation."

Clinical • Journal • Hypotension • Neuralgia • Pain

Guidelines for Seizure Prophylaxis in Patients Undergoing Supratentorial Neurosurgery: A Statement for Healthcare Professionals from the Neurocritical Care Society. (PubMed, Neurocrit Care) - "We suggest that either prophylactic ASM or no ASM be used for seizure prophylaxis in patients undergoing supratentorial neurosurgery (conditional recommendation, low quality of evidence). If an ASM is used, we suggest LEV over PHT (conditional recommendation, very low quality of evidence) for a short duration (conditional recommendation, very low quality of evidence)."

Journal • CNS Disorders • Epilepsy

Acquired Urea Cycle Disorder From Zinc Deficiency Causing Hyperammonemic Encephalopathy and Refractory Status Epilepticus (AAN 2026) - "On day six, she began having left-central-onset seizures, then generalized status epilepticus refractory to IV lorazepam 12mg, levetiracetam, fosphenytoin, and lacosamide, requiring multiple infusions. Prompt recognition and evaluation are essential to prevent injury, as in this case, without other explanation for her profound clinical picture. Concurrent B6 deficiency, impairing GABA synthesis, likely also contributed to seizure risk."

CNS Disorders • Epilepsy • Genetic Disorders • Metabolic Disorders

Comparative Effectiveness of Levetiracetam, Fosphenytoin, Lacosamide, and Valproate in Benzodiazepine-refractory Status Epilepticus: A Retrospective Study Based on ESETT Criteria (AAN 2026) - "Conclusions Preliminary, unadjusted intubation rates were comparable for VPA, PHT, and LAC, with a lower crude rate for LEV. These early signals need confirmation in an IRB-approved study that applies clear exposure rules, standardized timing, and risk adjustment, and that formally evaluates the ESETT 60-minute effectiveness endpoint."

HEOR • Retrospective data • CNS Disorders • Epilepsy

Refractory Status Epilepticus in an Infant with Succinic Semialdehyde Dehydrogenase Deficiency: A Case Report and Therapeutic Challenges (AAN 2026) - "Despite treatment with lorazepam, levetiracetam, fosphenytoin, and phenobarbital, seizures persisted, evolving into refractory status epilepticus. Ketamine infusion was started and escalated to 100 mcg/kg/min without resolution...Both anesthetic infusions were weaned over 20 days, during which levetiracetam, topiramate, clobazam, perampanel, and phenobarbital were uptitrated...Seizure type, frequency, and treatment response are highly variable, making therapy challenging. Status epilepticus in this setting presents unique therapeutic challenges, as many conventional antiseizure agents may exacerbate GABAergic imbalance; thus, management must balance seizure control while avoiding agents that impair GABA metabolism. There are no evidence-based, standardized protocols for managing seizures in SSADHD or many other metabolic epilepsies. This case underscores the complexity of treating metabolic epilepsies and the ongoing need for targeted, mechanism-based therapies."

Case report • Clinical • Absence Seizure Disorder • Attention Deficit Hyperactivity Disorder • CNS Disorders • Epilepsy • Infectious Disease • Metabolic Disorders • Novel Coronavirus Disease • Strabismus

Refractory Partial Status Epilepticus in the Setting of Anti-GAD65 Autoimmune Encephalitis in an 18-Year-Old Female with an MRI Contraindication: A Case Report (AAN 2026) - "The patient had stopped Keppra due to side effects...Despite increasing zonisamide, EEG showed left-sided PLEDs and right-sided non-convulsive seizures...Acyclovir and fosphenytoin were initially started, with EEG continuing to show seizures...Patient started to show improvement after rituximab, and especially after PLEX...She was discharged on fycompa, vimpat, and a prednisone taper with outpatient follow-up. Conclusions This case highlights the importance of early diagnosis of anti-GAD65 autoimmune encephalitis in young patients with new-onset seizures, even without MRI. Prompt treatment, including PLEX, can prevent progression to status epilepticus and support recovery."

Case report • Clinical • CNS Disorders • Epilepsy • Immunology

Seizures from Chronic Salicylate Intoxication Following Household Exposure to Incense Fumes. (PubMed, Am J Case Rep) - "BACKGROUND The incidence of acute salicylate intoxication in children has declined following regulatory measures such as limiting the aspirin content per tablet and the introduction of child-resistant packaging...During her stay in the pediatric intensive care unit, she experienced 2 additional seizures and was started on fosphenytoin...CONCLUSIONS All salicylate-containing products should carry clear and appropriate warning labels regarding potential toxicity. Health care providers should remain vigilant and consider environmental and household sources of salicylate exposure when evaluating unexplained metabolic acidosis or new-onset seizures in children."

Journal • CNS Disorders • Critical care • Epilepsy • Metabolic Disorders • Pediatrics

Management of pediatric status epilepticus after hospital arrival in Japan: A nationwide questionnaire survey. (PubMed, Brain Dev) - "Pediatric SE management in Japan emphasizes rapid treatment and flexible administration routes. Institutional experience is associated with differences in EEG utilization, protocol development, and SRSE management. Further improvement will require continued evidence generation, timely treatment implementation, and reduction of institutional disparities."

Journal • Anesthesia • CNS Disorders • Epilepsy • Pediatrics

Chronological Sequence of Convulsive Status Epilepticus Treatment Steps in a Real-Life Scenario for Patients Enrolled in a Large Multicenter Trial. (PubMed, Acad Emerg Med) - "Although many treatment steps occurred within recommended windows, considerable variability exists. Prehospital benzodiazepine use was often absent, and in-hospital treatment timing was inconsistent. Earlier delivery of second-line therapy correlated with improved outcomes. These real-world data provide a lens through which to better understand the causes and impact of practice variability in time to treatment and assess the extent to which current guidelines on timing may be important, but also how they may be ambiguous or unrealistic."

Clinical • Journal • CNS Disorders • Epilepsy

Lidocaine Infusion for Super-Refractory Status Epilepticus: A Retrospective Review (SCCM 2026) - "Introduction: Super-refractory status epilepticus (SRSE) is SE that persists for more than 24 hours despite continuous infusions of anesthetics such as midazolam or pentobarbital...Patients were treated with benzodiazepines (bolus and/or infusion) (n=5), levetiracetam (n=5), pentobarbital (n=4), phenobarbital (n=5), fosphenytoin (n=3), lacosamide (n=1), topiramate (n=1), and corticotropin (n=1) prior to lidocaine infusion...Supratherapeutic concentrations over 8 mcg/mL may increase the risk for seizures. The presented cases suggest lidocaine infusion may be an alternative agent in the management of pediatric SRSE."

Retrospective data • Review • Cardiovascular • CNS Disorders • Epilepsy • Hypotension

Early Versus Late Use of Lacosamide as an Antiseizure Medication in Refractory Status Epilepticus (SCCM 2026) - "Introduction: Status epilepticus is initially treated with a benzodiazepine followed by a first-line anti-seizure medication (ASM) such as levetiracetam, valproic acid or fosphenytoin...Initial treatment prior to lacosamide included a median of 2.4 mg lorazepam equivalents in the early group and 3.5 mg lorazepam equivalents in the late group... Early use of lacosamide in RSE was associated with significantly fewer ASMs used and numerically higher rates of seizure cessation, suggesting potential clinical benefit despite lack of statistical significance in the primary outcome. Further studies with larger sample sizes are warranted to validate these results."

CNS Disorders • Epilepsy

Efficacy, Safety, and Pharmacokinetics of Lacosamide in Neonates With Seizures: Results of a Phase 2/3, Open-Label, Randomized, Active Comparator Trial (AES 2025) - P2 | "The AC treatments received were phenobarbital (5 [41.7%]), fosphenytoin (5 [41.7%]), and levetiracetam (2 [16.7%]). In this first randomized clinical trial of LCM in neonates, LCM treatment reduced seizure burden and was well tolerated. Although LCM exposure tended to be higher in neonates, serum concentrations were generally in agreement with exposure in adults at a dose of 400 mg/day LCM (without use of inducers)."

Clinical • P2/3 data • PK/PD data • CNS Disorders • Epilepsy

Long-Term Efficacy of Lacosamide in the Treatment of Early-Onset Epilepsy: A Case Series (AES 2025) - "All patients presented in SE that was unresponsive to standard first-line therapies including lorazepam, fosphenytoin, phenobarbital, and in some cases, oxcarbazepine or levetiracetam. This case series supports the safety and potential efficacy of lacosamide in managing early-onset epilepsy, particularly in infants presenting with refractory SE. The rapid resolution of seizures and the absence of cardiac conduction abnormalities, combined with favorable long-term outcomes, suggest that lacosamide may be a valuable addition to the early treatment algorithm for infantile epilepsy2. Further prospective studies with larger cohorts are warranted to confirm these findings and to establish optimal dosing protocols in this vulnerable population."

Clinical • CNS Disorders • Epilepsy

Retrospective Study on a Pediatric Status Epilepticus Pathway (AES 2025) - "Levetiracetam, fosphenytoin, and valproic acid demonstrated no statistically significant differences in efficacy for terminating benzodiazepine-resistant convulsive status epilepticus in our patient cohort."

Retrospective data • CNS Disorders • Epilepsy • Infectious Disease • Pediatrics

Adult Diagnosed Dravet Syndrome: Challenges and Opportunities (AES 2025) - "DS was diagnosed in three patients, one of whom is three years seizure free after withdrawal of lamotrigine...Due to recurrent and prolonged myoclonic-tonic-clonic seizures, his rescue medication was changed from benzodiazepines to buccal fosphenytoin which has effectively reduced the frequency of status epilepticus. Genetic testing should be considered in all adults with unexplained DRE and ID... Genetic testing should be considered in all adults with unexplained DRE and ID. When an SCN1A variant is identified, it is important to consider the phenotype, the variants pathogenicity and its function. These cases highlight the significant impact on seizure control and quality of life that a change in SCB's can have, even in adults."

Clinical • CNS Disorders • Developmental Disorders • Epilepsy • Mental Retardation • Movement Disorders • Parkinson's Disease

Phenytoin / fosphenytoin is Superior to Levetiracetam as Second Line Therapy for Neonatal Seizures, an Observational Cohort Study at 16 Centers (AES 2025) - "We aimed to compare the effectiveness of phenytoin/fosphenytoin (PHT) vs levetiracetam (LEV) in neonates with acute provoked seizures that continued despite initial treatment with phenobarbital, using causal inference techniques for observational data. We reviewed charts of neonates with seizures at 16 institutions using the Pediatric Epilepsy Learning Healthcare System. Phenytoin/fosphenytoin is superior to levetiracetam for second line therapy for neonatal seizures, for both 24 and 72 hours of seizure cessation, based on causal inference with observational data at multiple centers. Confidence in the finding is strengthened by a large effect size (OR > 2), measured confounding favored LEV (sicker neonates received PHT), and robustness to unmeasured confounding (E-value > 2)."

Clinical • Observational data • CNS Disorders • Epilepsy

AN ELUSIVE CASE OF SUPER REFRACTORY STATUS EPILEPTICUS (CHEST 2025) - "His seizures were uncontrolled despite high doses of propofol (70 mcg/kg/min), and other AEDs were also added incrementally (levetiracetam 2 g twice daily, lacosamide 200 mg twice daily, valproic acid 500 mg every 6 hours, topiramate 200 mg every 12 hours, phenobarbital 130 mg daily, perampanel 16 mg daily (after a loading dose of 24 mg)...We also performed plasmapheresis (every other day for 5 times), pulse dose steroids (1 g intravenous methylprednisolone for 5 days) till auto-immune and paraneoplastic workup came back as negative...Commonly used IVAs include midazolam, pentobarbital, and propofol, with alternatives being ketamine, isoflurane, desflurane and brexanolone. Commonly used AEDs are phenobarbital, phenytoin, fosphenytoin, levetiracetam, valproate, and lacosamide, while some of the newer ones include brivaracetam, clobazam, and rufinamide... SRSE is a complex clinical condition requiring further research to establish optimal management tactics. Our patient..."

Clinical • Addiction (Opioid and Alcohol) • Aesthetic Medicine • Anesthesia • Epilepsy • Immunology • Infectious Disease • Pneumonia • Respiratory Diseases • Septic Shock • Vascular Neurology

A CLINICAL CONUNDRUM: IS IT JUST DEMENTIA? IS IT A NEW STROKE? A BRIEF OVERVIEW OF NONCONVULSIVE STATUS EPILEPTICUS (CHEST 2025) - "She was transferred to the ICU for treatment with fosphenytoin and intravenous immunoglobulin, given her history of autoimmune encephalitis. Additional antiepileptics, including valproic acid and lacosamide, were required, and she was later transferred to a facility with continuous EEG monitoring.Her treatment plan included levetiracetam, valproic acid, intravenous methylprednisolone, and intravenous immunoglobulin. Post-ictal psychosis developed, treated with olanzapine, and she was discharged back to her baseline condition... This case highlights the importance of considering NCSE in patients with unexplained changes in neurological status, especially in the absence of overt seizures. Despite advances in rapid EEG, traditional EEG remains critical for accurate diagnosis. Timely intervention is essential, and even with delays, appropriate management can lead to favorable outcomes."

Clinical • Alzheimer's Disease • Cardiovascular • CNS Disorders • Dementia • Depression • Diabetes • Epilepsy • Hypertension • Immunology • Infectious Disease • Metabolic Disorders • Psychiatry • Type 2 Diabetes Mellitus

Fosphenytoin may be effective in shortening the half-life of lamotrigine in case of overdose: a case report. (PubMed, J Med Case Rep) - "Fosphenytoin administration may be effective for treating lamotrigine overdose."

Journal • Cardiovascular • CNS Disorders • Epilepsy

A retrospective comparison of prophylactic fosphenytoin and levetiracetam in awake craniotomy. (PubMed, J Clin Neurosci) - "Though there was no difference in rate of intraoperative and postoperative seizure, the lower rate of transient neurologic deficit and intraoperative events suggests prophylactic fosphenytoin may improve safety of awake craniotomy with DCS compared to levetiracetam."

Journal • Retrospective data • CNS Disorders • Epilepsy • Pediatrics