***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective Although generalized convulsive status epilepticus ( GCSE ) is a life-threatening emergency , evidence -based data to guide initial drug treatment choices are lacking in the Chinese population . We conducted this prospect i ve , r and omized , controlled trial to evaluate the relative efficacy and safety of intravenous phenobarbital and valproate in patients with GCSE . Methods After the failure of first-line diazepam treatment , Chinese adult patients with GCSE were r and omized to receive either intravenous phenobarbital ( st and ard doses , low rate ) or valproate ( st and ard ) . Successful treatment was considered when clinical and electroencephalographic seizure activity ceased . Adverse events following treatment , as well as the neurological outcomes at discharge and 3 months later , were also evaluated . Results Overall , 73 cases were enrolled in the study . Intravenous phenobarbital was successful in 81.1 % of patients , and intravenous valproate was successful in 44.4 % of patients ( p < 0.05 ) . The relapse rate of status epilepticus within 24 h of receiving phenobarbital ( 6.7 % ) was significantly lower than that in patients receiving valproate ( 31.3 % ) , and the total number of adverse events did not differ significantly between the two groups ( p > 0.05 ) . In the phenobarbital group , two patients ( 5.4 % ) required ventilation and two patients ( 5.4 % ) developed serious hypotension . The neurological outcomes of the phenobarbital group were generally better than those of the valproate group ; however , no significant differences were observed between phenobarbital and valproate with respect to mortality ( 8.1 vs. 16.6 % ) at discharge , or mortality ( 16.2 vs. 30.5 % ) and post-symptomatic epilepsy ( 26.3 vs. 42.8 % ) at 3-month follow-up . Conclusions Intravenous phenobarbital appears to be more effective than intravenous valproate for Chinese adult patients with GCSE . The occurrence of serious respiratory depression and hypotension caused by phenobarbital was reduced by decreasing the intravenous infusion rate ; however , even at a lower infusion rate than typically used in other institutions , intravenous phenobarbital result ed in more serious adverse events than intravenous valproate . The better outcomes in the phenobarbital group compared with the valproate group suggest that phenobarbital should be considered for the early successful treatment of GCSE INTRODUCTION The evidence based data to guide management in patients of benzodiazepine refractory status epilepticus ( SE ) is still lacking . We conducted a r and omized study to evaluate the comparative effect of intravenous ( IV ) phenytoin and intravenous valproate ( IV VA ) in patients of benzodiazepine refractory SE . BACKGROUND AND METHODS Hundred , age and sex matched , patients of benzodiazepine refractory SE were r and omly divided into Group A ( 50 patients ) , treated with IV VA and Group B ( 50 patients ) treated with IV phenytoin .  Twelve patients , in whom SE was not controlled with a single drug , were switched over to the other group . Treatment was considered successful when all motor or EEG seizure activity ceased within 20 min after the beginning of the drug infusion and no return of seizure activity during the next 12h . Secondary study end points were adverse events to treatment , in-hospital complications and the neurological outcome at discharge . RESULTS In this study , IV VA was successful in 88 % and IV phenytoin in 84 % ( p>0.05 ) of patients of SE with a significantly better response in patients of SE < 2h ( p<0.05 ) . The total number of adverse events did not differ significantly between the two groups ( p>0.05 ) . There were no differences among the treatments with respect to recurrence after 12-h study period or the outcome at 7 days . CONCLUSION IV VA is as effective as IV phenytoin . It is easy to use , better tolerated and can be used as an alternative to IV phenytoin in patients of benzodiazepine refractory SE , especially in patients of cardio-respiratory disease . The better outcome in patients having shorter duration of SE ( < 2h ) suggests need of immediate treatment Background Convulsive status epilepticus ( CSE ) is the most common life-threatening childhood neurological emergency . Despite this , there is a lack of high quality evidence supporting medication use after first line benzodiazepines , with current treatment protocol s based solely on non-experimental evidence and expert opinion . The current st and ard of care , phenytoin , is only 60 % effective , and associated with considerable adverse effects . A newer anti-convulsant , levetiracetam , can be given faster , is potentially more efficacious , with a more tolerable side effect profile . The primary aim of the study presented in this protocol is to determine whether intravenous ( IV ) levetiracetam or IV phenytoin is the better second line treatment for the emergency management of CSE in children . Methods / Design 200 children aged between 3 months and 16 years presenting to 13 emergency departments in Australia and New Zeal and with CSE , that has failed to stop with first line benzodiazepines , will be enrolled into this multicentre open r and omised controlled trial . Participants will be r and omised to 40 mg/kg IV levetiracetam infusion over 5 min or 20 mg/kg IV phenytoin infusion over 20 min . The primary outcome for the study is clinical cessation of seizure activity five minutes following the completion of the infusion of the study medication . Blinded confirmation of the primary outcome will occur with the primary outcome assessment being video recorded and assessed by a primary outcome assessment team blinded to treatment allocation . Secondary outcomes include : Clinical cessation of seizure activity at two hours ; Time to clinical seizure cessation ; Need for rapid sequence induction ; Intensive care unit ( ICU ) admission ; Serious adverse events ; Length of Hospital/ICU stay ; Health care costs ; Seizure status/death at one-month post discharge . Discussion This paper presents the background , rationale , and design for a r and omised controlled trial comparing levetiracetam to phenytoin in children presenting with CSE in whom benzodiazepines have failed . This study will provide the first high quality evidence for management of paediatric CSE post first-line benzodiazepines . Trial registration Prospect ively registered with the Australian and New Zeal and Clinical Trial Registry ( ANZCTR ) : ACTRN12615000129583 ( 11/2/2015 ) . UTN U1111–1144 - 5272 . ConSEPT protocol version 4 ( 12/12/2014 ) Importance Treatment delay for seizures can lead to longer seizure duration . Whether treatment delay is associated with major adverse outcomes , such as death , remains unknown . Objective To evaluate whether untimely first-line benzodiazepine treatment is associated with unfavorable short-term outcomes . Design , Setting , and Participants This multicenter , observational , prospect i ve cohort study included 218 pediatric patients admitted between June 1 , 2011 , and July 7 , 2016 , into the 11 tertiary hospitals in the United States within the Pediatric Status Epilepticus Research Group . Patients , ranging in age from 1 month to 21 years , with refractory convulsive status epilepticus ( RCSE ) that did not stop after the administration of at least 2 antiseizure medications were included . Patients were divided into 2 cohorts : those who received the first-line benzodiazepine treatment in less than 10 minutes and those who received it 10 or more minutes after seizure onset ( untimely ) . Data were collected and analyzed from June 1 , 2011 , to July 7 , 2016 . Main Outcomes and Measures The primary outcome was death during the related hospital admission . The secondary outcome was the need for continuous infusion for seizure termination . Multivariate analysis of mortality controlled for structural cause , febrile RCSE , age , and previous neurological history ( including previous RCSE events ) . Use of continuous infusions was additionally adjusted for generalized RCSE , continuous RCSE , and 5 or more administrations of antiseizure medication . Results A total of 218 patients were included , among whom 116 ( 53.2 % ) were male and the median ( interquartile range ) age was 4.0 ( 1.2 - 9.6 ) years . The RCSE started in the prehospital setting for 139 patients ( 63.8 % ) . Seventy-four patients ( 33.9 % ) received their first-line benzodiazepine treatment in less than 10 minutes , and 144 ( 66.1 % ) received untimely first-line benzodiazepine treatment . Multivariate analysis showed that patients who received untimely first-line benzodiazepine treatment had higher odds of death ( adjusted odds ratio [ AOR ] , 11.0 ; 95 % CI , 1.43 to ∞ ; P = .02 ) , had greater odds of receiving continuous infusion ( AOR , 1.8 ; 95 % CI , 1.01 - 3.36 ; P = .047 ) , had longer convulsive seizure duration ( AOR , 2.6 ; 95 % CI , 1.38 - 4.88 ; P = .003 ) , and had more frequent hypotension ( AOR 2.3 ; 95 % CI , 1.16 - 4.63 ; P = .02 ) . In addition , the timing of the first-line benzodiazepine treatment was correlated with the timing of the second-line ( 95 % CI , 0.64 - 0.95 ; P < .001 ) and third-line antiseizure medications ( 95 % CI , 0.25 - 0.78 ; P < .001 ) . Conclusions and Relevance Among pediatric patients with RCSE , an untimely first-line benzodiazepine treatment is independently associated with a higher frequency of death , use of continuous infusions , longer convulsion duration , and more frequent hypotension . Results of this study raise the question as to whether poor outcomes could , in part , be prevented by earlier administration of treatment Background Convulsive status epilepticus ( CSE ) is the most common life-threatening neurological emergency in childhood . These children are also at risk of significant morbidity , with acute and chronic impact on the family and the health and social care systems . The current recommended first-choice , second-line treatment in children aged 6 months and above is intravenous phenytoin ( fosphenytoin in the USA ) , although there is a lack of evidence for its use and it is associated with significant side effects . Emerging evidence suggests that intravenous levetiracetam may be effective as a second-line agent for CSE , and fewer adverse effects have been described . This trial therefore aims to determine whether intravenous phenytoin or levetiracetam is more effective , and safer , in treating childhood CSE . Methods / design This is a phase IV , multi-centre , parallel group , r and omised controlled , open-label trial . Following treatment for CSE with first-line treatment , children with ongoing seizures are r and omised to receive either phenytoin ( 20 mg/kg , maximum 2 g ) or levetiracetam ( 40 mg/kg , maximum 2.5 g ) intravenously . The primary outcome measure is the cessation of all visible signs of CSE as determined by the treating clinician . Secondary outcome measures include the need for further anti-seizure medications or rapid sequence induction for ongoing CSE , admission to critical care areas , and serious adverse reactions .  Patients are recruited without prior consent , with deferred consent sought at an appropriate time for the family . The primary analysis will be by intention-to-treat . The primary outcome is a time to event outcome and a sample size of 140 participants in each group will have 80 % power to detect an increase in CSE cessation rates from 60 % to 75 % . Our total sample size of 308 r and omised and treated participants will allow for 10 % loss to follow-up . Discussion This clinical trial will determine whether phenytoin or levetiracetam is more effective as an intravenous second-line agent for CSE , and provide evidence for management recommendations . In addition , this trial will also provide data on which of these therapies is safer in this setting .Trial registration IS RCT N identifier , IS RCT N22567894 . Registered on 27 August 2015EudraCT identifier , 2014 - 002188 - 13 . Registered on 21 May 2014NIHR HTA Grant : Objective – Status epilepticus ( SE ) and serial attacks ( SA ) represent neurological emergencies , and mortality rate for SE/SA is high , ranging from 3 % to 25 % , depending on cause and co‐morbidity . As SE/SA become more refractory to treatment over time , rapid , appropriate treatment is extremely important . Here , we report a prospect i ve registration of the effect of intravenous ( IV ) valproate ( VPA ) on SE/SA in a group of Norwegian patients The purpose of this study was to compare safety and efficacy of intravenous ( IV ) levetiracetam ( LEV ) with IV phenytoin ( PHT ) in management of  status epilepticus ( SE ) .  The second-line treatment of SE is limited to a few drugs available in an IV formulation such as PHT , fosphenytoin and valproate . The relative lack of serious side effects and favourable pharmacokinetics of LEV made it a promising option in management of SE . R and omized tri 
    Output:
    
PHT and lacosamide were not cost-effective compared to the other options .
Sensitivity analyses showed marked overlap in cost-effectiveness , but PHT was consistently less cost-effective than LEV , VPA , and PB .
Conclusion VPA and PB were more effective than PHT for SE .
There is substantial overlap in the cost-effectiveness of non-BZD AEDs for SE , but available evidence does not support the preeminence of PHT , neither in terms of effectiveness nor in terms of cost-effectiveness