Ketamine and Levetiracetam as Second-line Antiseizure Medication for Status Epilepticus in Children

Inclusion Criteria: * Age from 1 year to 16 years. * Generalized convulsive status epilepticus (GCSE), defined as clinically observed generalized tonic-clonic convulsions that continue or recur without complete regaining of consciousness in between for longer than 5 minutes. * Benzodiazepine-refractory, defined as continuous or recurrent GCSE in the emergency room after receiving an adequate benzodiazepine dose, with the last dose administered within 5 to 30 minutes. Exclusion Criteria: * Failure to obtain informed consent. * Prior treatment with antiseizure medication or anticonvulsant sedatives other than benzodiazepines for the presenting GCSE episode. * Endotracheal intubation before enrollment. * Acute traumatic brain injury. * Cardiac arrest/post-anoxic seizures * Hypoglycemia or hyperglycemia. * Known allergies or contraindications to ketamine or levetiracetam * Failure to obtain intravenous access.