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Neurology India, Vol. 51, No. 3, July, 2003, pp. 421 Intravenous sodium valproate in status epilepticus Jha S, Jose M, Patel R Correspondence Address: Code Number: ni03142 ABSTRACT A study was conducted to observe the effect of intravenous sodium valproate in status epilepticus. Eleven patients with status epilepticus, who were resistant to conventional drugs, underwent treatment with intravenous sodium valproate. The seizures were controlled in 10 patients within 24-48 hrs of starting treatment. No complications were observed during therapy. We conclude that intravenous sodium valproate can be recommended for Myoclonic status epilepticus and non-convulsive status epileticus. INTRODUCTION A variety of drugs have been used for the treatment of status epilepticus (SE). Recently, intravenous sodium valproate has been demonstrated to be effective and safe in the treatment of SE.[1],[2] We report our experience with 11 patients of SE who were resistant to conventional drugs and were treated with intravenous sodium valproate. MATERIAL AND METHODS The details of the patients are summarized in [Table-1]. All the patients were managed as per conventional guidelines for SE. The dose of LZ administered was 0.1 mg /kg IV at 2 mg/min. If the seizures persisted after 5-10 min, phenytoin was introduced in a dose of 20 mg /kg at 50 mg/min. If SE persisted for another 15-20 min, the drug was re-administered at a lower dose of 5-10 mg/kg. Intravenous sodium valproate was infused after failure of the above regimen in a dose of 20 mg/kg at 20 mg/min. The drug was repeated whenever required. RESULTS There were 5 patients of EPC, 4 of MSE and one patient each of NCSE and GTC. Ten patients showed clinical improvement and seizures were controlled within 12-36 hours without any adverse effects. There was no respiratory depression, cardiac arrhythmia or hypotension. These patients remained seizure-free and were then strated on oral anticonvulsant drugs. The efficacy of the treatment did not depend on the type of seizure. There was 1 patient of MSE who did not respond to intravenous sodium valproate alone and required an additional infusion of DZ for control of seizures. DISCUSSION SE is a life-threatening condition. Oral sodium valproate has established itself as a major antiepileptic drug having efficacy for treatment of both generalized and partial seizures. The role of intravenous sodium valproate in the management of SE is not well established, although controlled trials have shown encouraging results.[3] Antiepileptic drug-induced hypotension is a well-recognized complication during the management of SE. It has been observed and reported by us that intravenous sodium valproate does not adversely affect the blood pressure.[1] The FDA currently recommends intravenous sodium valproate infusion at the rate of 20 mg/ min. Recent studies have reported tolerability of 50 mg /min infusion in adults with acute seizures and 3-6 mg/ kg/ min infusion in patients with epilepsy.[1] A high success rate of intravenous sodium valproate has been observed in other studies.[4],[5] This may be due to the rapid penetration of the drug into the brain tissue.[6] We conclude that intravenous sodium valproate can be considered as the first line therapy for EPC. It is also effective and safe in NCSE and Myoclonic status epilepticus.[7] REFERENCES
Copyright 2003 - Neurology India. Also available online at http://www.neurologyindia.com The following images related to this document are available:Photo images[ni03142t1.jpg] |
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![[Table-1]](/showimage?ni/photo/ni03142t1.jpg){kind=link}