Intravenous valproate as an innovative therapy in seizure emergency situations including status epilepticus--experience in 102 adult patients.
OBJECTIVE
The emergency treatment of seizures is an important practical issue, in particular the therapy of status epilepticus. Antiepileptic drugs for this condition should be easy to use, show rapid action, have a long-lasting antiepileptic effect, and have minimal cardiopulmonary and other side-effects. Unfortunately, none of the presently available medications such as phenytoin and barbiturates seems to have all of these four properties. Intravenous valproate became available some years ago and first experiences show promising safety data and efficacy results.


METHODS
We report a series of 102 adult patients who received standardized high dosage intravenous valproate in various emergency situations, including status epilepticus. The therapeutic goal was persistent seizure control, defined as successful interruption of clinical seizure activity within less than 15 min, followed by seizure freedom during intravenous therapy for at least 12h. All side effects were documented.


RESULTS
In 83/97 patients (85.6%) the therapeutic goal was achieved. Serious side effects were not documented in any patient. In particular there was no evidence of sedation, cardiorespiratory disturbances and hypotension as often seen in barbiturates and phenytoin. Mild side effects occurred in seven cases (6.9%).


CONCLUSIONS
The intravenous application of VPA seems to be an easy-to-use, safe and efficient formulation as an alternative to phenytoin in all seizure emergency situations including status epilepticus. Further controlled comparison studies have to be performed in the future.
Peters
Christian N A
CN
Department of Neurology, Klinikum Mannheim, University of Heidelberg, Mannheim, Germany. peters@neuro.ma.uni-heidelberg.de
Pohlmann-Eden
Bernd
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage*; D001569:Benzodiazepines / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage; D011446:Prospective Studies; D011930:Reaction Time / Q000187:drug effects; D012189:Retrospective Studies; D012640:Seizures / Q000188:drug therapy*; D013226:Status Epilepticus / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage*
D000927:Anticonvulsants; D001569:Benzodiazepines; D014635:Valproic Acid; D010672:Phenytoin