Abstract: Objective To comprehensively evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) in the treatment of convulsive status epilepticus (CSE) in children. Methods The PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Database, China Biomedical Literature Database (CBM) and VIP Chinese science and technology periodical database (VIP) were retrieved. The retrieval period is from the database construction to July 17 , 2020 . Prospective randomized controlled trials (RCTs) of intravenous PHT (control group) and intravenous LEV (intervention group) for the treatment of children with CSE were screened. The data that met the inclusion criteria were extracted and their quality was evaluated, and meta-analysis was performed using Rev Man 5 . 3 software. Results A total of 7 RCTs were included, including 1647 children with CSE. The meta-analysis results showed that the complete control rate of clinical seizures within 60 minutes in the LEV group was slightly higher than that in the PHT group, but the difference was not statistically significant (RR=1 . 06 , 95%CI:1.00-1.13, P=0. 06 ). There was no statistical difference in clinical recurrence rate within 24 hours (RR=0.93, 95%CI: 0.50-1.74, P=0 . 83 ), mortality rate (RR=0.89, 95%CI: 0.18-4.48, P=0 . 89 ), ICU admission rate (RR=1 . 11 , 95 %CI: 0 . 96 - 1 . 28 , P=0 . 17 ) between the LEV group and the PHT group. The total incidence of adverse events in the LEV group was lower than that in the PHT group, and the difference was statistically significant (RR=0 . 74 , 95 %CI: 0 . 60 - 0 . 92 , P=0 . 006 ). Conclusions LEV is comparable to the second-line preferred drug PHT in children with CSE after benzodiazepine treatment failure; furthermore, LEV has low overall incidence of adverse events and may be considered as a suitable alternative to PHT.

Key words: levetiracetam; phenytoin; status epilepticus; meta-analysis