fosphenytoin / Generic mfg. - LARVOL DELTA

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

REAL-WORLD INCIDENCE OF LIVER ENZYME ELEVATION DUE TO MEDICATIONS IN HOSPITALIZED INDIVIDUALS: CHALLENGES AND OPPORTUNITIES OF USING BIG DATA TO STUDY HEPATOTOXICITY (AASLD 2025) - "Among medications with the highest crude incidence were high-dose methotrexate (MTX), fosphenytoin, and neostigmine... Large-scale clinical data enables identification of both known and less studied potential drug-induced liver injury causes. Our unbiased approach validated known hepatotoxicity of high-dose MTX as a positive control and highlighted the importance of considering confounding factors. Despite limitations in confounding and diagnostic specificity, this method may represent an important advance in pharmacoepidemiologic research on hepatic safety."

Clinical • Real-world • Real-world evidence • Hepatology • Liver Failure

Case Report: Management of Hemiconvulsion Hemiplegic Epilepsy Syndrome Utilizing Ketamine and Ketogenic Diet (AAP-NCE 2025) - "She received levetiracetam and fosphenytoin loads but was admitted to the PICU intubated due to hypoxemic respiratory failure and RSE. In this unique case, through the utilization and optimization of ketamine and ketogenic diet, we were able to obtain seizure cessation, and advocate for earlier utilization of these measures in RSE/SRSE and HHES."

Case report • Clinical • CNS Disorders • Epilepsy • Hypoglycemia • Immunology • Infectious Disease • Respiratory Diseases

Benzodiazepine-refractory status epilepticus: A narrative review. (PubMed, Am J Emerg Med) - "Recognizing and treating SE early is critical for preserving neurologic function. Emergency clinicians must be prepared to reverse the underlying causes of SE and utilize second- and third-line ASMs to abort seizure activity when necessary."

Journal • Review • CNS Disorders • Epilepsy • Obstetrics

Fast Acute Sedation at Intensive Care vs. High-Dose IV Anti-seizure Medication for Treatment of Non-convulsive Status Epilepticus: A Randomized, Multicenter Trial. (PubMed, Crit Care Explor) - P3 | "The FAST trial is the first randomized clinical trial to investigate refractory NCSE. Regardless of the outcome, the results of this trial protocol will provide new class 1 evidence for the treatment of NCSE and establish the standard of care for this patient population in the future."

Clinical • Journal • Anesthesia • CNS Disorders • Critical care • Epilepsy • Infectious Disease

Drugs and Nutrients in Epilepsy: Vitamin B6 and the Ketogenic Diet. (PubMed, Nutrients) - "Drugs include fosphenytoin (40%), topiramate (37%), valproic acid (34%), hydantoin (20%), phenytoin (31%), carbamazepine (33%), carbamazepine-10,11-epoxide (40%), trimethadione (31%), gabapentin (14%), pregabalin (11%), flunarizine (7%), fenfluramine (4%), bumetanide (4%), KBr (18%), cannabidiol (14%), clonazepam (22%), nitrazepam (10%), diazepam (7%), lorazepam (6%), midazolam (3%), amobarbital (21%), phenobarbital (16%), flumazenil (7%) allopregnanolone (7%), pregnanolone (6%), epipregnanolone (6%), 3-hydroxypregnan-20-one (6%), and vitamin B6 (6%)...Inducers include flurothyl (37%), pentetrazol (32%), pilocarpine (25%), (+)-Bicuculline (8%), and 1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine (MPTP, 6%). Our analysis highlights frequently cited associations between epilepsy and specific drugs and highlights the importance of supplementing nutrients with vitamin B6 and the ketogenic diet, which increases the gamma-aminobutyric acid (GABA)/glutamate ratio. As such, our..."

Journal • Review • CNS Disorders • Epilepsy

Perampanel for alleviation of secondary injury in traumatic brain injury (PEACE-TBI): a protocol for a phase-II multicentre randomised clinical trial. (PubMed, BMJ Open) - "The study participants will be randomly assigned to either the perampanel group (2 mg/day) or the control group (fosphenytoin administered at a dose of 15-18 mg/kg/day, followed by 5-7.5 mg/kg/day of fosphenytoin). The results will be disseminated via publications and presentations. Japan Registry of Clinical Trials (jRCTs031250067)."

Clinical protocol • Journal • P2 data • CNS Disorders • Epilepsy • Vascular Neurology

Efficacy and safety of levetiracetam for pediatric convulsive status epilepticus in emergency settings: a systematic review and meta-analysis. (PubMed, BMC Neurol) - "The study concludes better immediate effects of levetiracetam such as faster cessation of seizures. Levetiracetam was also suggested to stabilize patients faster, as implied by the lesser ICU stay and lower risk of adverse events. Further studies are needed to evaluate the efficacy of levetiracetam over other anti-seizure medications."

Journal • Retrospective data • Review • CNS Disorders • Epilepsy • Pediatrics

Levetiracetam Versus Fosphenytoin Infusions as Second-Line Treatment for Pediatric Status Epilepticus: A Multicenter Study Examining Effectiveness, Tolerability, and Ease of Use. (PubMed, Paediatr Drugs) - "Using a composite outcome measure, we demonstrated that levetiracetam was not inferior to fosphenytoin with respect to seizure recurrence, the need for third-line therapy, intensive care unit admission, and the total length of hospital stays."

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

Levetiracetam versus phenytoin/fosphenytoin for second-line treatment of children with convulsive status epilepticus: an up-to-date meta-analysis and systematic review of randomized controlled trials. (PubMed, Front Neurol) - "No significant differences were observed in the need for mechanical ventilation, intensive care unit admission, or hospital length of stay. Levetiracetam is as effective as phenytoin/fosphenytoin to control seizures in children with CSE and is associated with fewer seizure recurrences and adverse events."

Journal • Retrospective data • Review • CNS Disorders • Critical care • Epilepsy

The Impact of Standard Versus Weight-Based Maintenance Dosing of Fosphenytoin on Achieving Therapeutic Drug Levels. (PubMed, J Clin Pharmacol) - "This study found no difference in the incidence of first serum phenytoin level being therapeutic based on fosphenytoin dosing strategy utilized. Further prospective studies should be conducted to evaluate fosphenytoin maintenance dosing strategies."

Journal • CNS Disorders • Epilepsy

Effective Protection Against Status Epilepticus Caused by Lithium-Pilocarpine: Combination of Midazolam and Lacosamide. (PubMed, Brain Behav) - "In the status epilepticus model induced by lithium-pilocarpine, the combination of MDZ + LCM was found to be the most effective polytherapy option in reducing seizures and mortality. Additionally, it was observed that LEV, LCM, and VPA administered together with MDZ did not negatively affect both cognitive and motor functions."

Journal • CNS Disorders • Epilepsy

Anti-Seizure Medication Use in Neonates: Real World Evidence of Changing Treatment Patterns (PAS 2025) - "A recent multicenter, randomized, controlled clinical trial, NEOLEV2, showed phenobarbital was significantly more effective than levetiracetam in controlling seizures. Out of 285,489 patients hospitalized within 28 days of birth from 2010-2023, we identified a cohort of 3,726 neonates meeting inclusion criteria. This cohort (Table 1) was mostly term infants (74%) and male (58%). Figure 1 shows the rates of ASMs used, with percentages representing neonates receiving any of the ASMs each year."

Clinical • HEOR • Real-world • Real-world evidence • CNS Disorders • Epilepsy

Intravenous Fosphenytoin Therapy for Acute Trigeminal Neuralgia: A Phase 3 Randomized Clinical Trial (IFT Study) (AAN 2025) - "The adverse events observed in ≥ 2 patients in the fPHT group were mild to moderate somnolence, blood pressure decreased, and nausea; the treatment was well tolerated. Conclusions Having a quick pain-relieving effect, with good tolerability, on acute TN exacerbations, intravenous fPHT may provide a new treatment for such patients suffering difficult pain control with oral drugs in emergencies and patients awaiting microvascular decompression, gamma knife radiosurgery, or nerve block treatment."

Clinical • Late-breaking abstract • P3 data • Neuralgia • Pain

Is Levetiracetam's Efficacy in Benzodiazepine-Refractory Convulsive Status Epilepticus Affected in Patients Prior to Admission Use? (IARS-SOCCA 2025) - "Introduction:When treating patients with benzodiazepine-refractory convulsive status epilepticus, the common and recommended anti-seizure medication choices are levetiracetam, fosphenytoin, and valproic acid (1). Refractoriness of treatment is clearly related to outcome with mortality rising from 10% in responsive cases, to 25% in refractory, and nearly 40% in super-refractory SE. (5). We did not see a difference in seizure control between our two groups with our primary outcome (PTA levetiracetam vs no PTA levetiracetam)."

Clinical • Anesthesia • CNS Disorders • Epilepsy

Group D Salmonella Meningitis in the Neonate (AAN 2025) - "Blood and CSF cultures grew Salmonella group D of presumed vertical transmission at birth and patient was initiated on a protracted course of ceftazidime...Seizures were refractory to initial treatment of phenobarbital, fosphenytoin, levetiracetam and midazolam infusion requiring escalation of treatment to include lacosamide, clobazam, and ultimately ketamine infusion for secondary neuroprotection...NTS meningitis, is a rare yet severe CNS infection with a high mortality rate, and potential for multiple neurologic complications. Early diagnosis and proactive neuromonitoring in the form of continuous EEG and sequential neuroimaging are essential for prompt treatment to optimize outcomes through secondary injury prevention."

CNS Disorders • Epilepsy • Hematological Disorders • Hepatology • Infectious Disease • Movement Disorders • Respiratory Diseases • Ventriculomegaly

Sphenopalatine Ganglion Blocks for the Treatment of Trigeminal Neuralgia Flares (AAN 2025) - "Infusions of fosphenytoin and other anti-seizure medications are commonly offered treatments which are not always enough to stop the attacks...SPG blocks via cotton tip application appear to be a safe and effective option for managing TN flares in the outpatient setting, providing rapid pain relief with minimal side effects. Further research with larger sample sizes and long-term follow-up is warranted to confirm these findings and optimize treatment protocols."

CNS Disorders • Epilepsy • Neuralgia • Pain