title: Fluctuating and constant valproate administration gives equivalent seizure control in rats with genetic and acquired epilepsy.
abstract: OBJECTIVE
  Controlled-release formulations of Valproate (VPA) reduce side effects by minimizing peak plasma VPA concentrations in patients with epilepsy. However, the impact of this on anti-seizure efficacy has not been thoroughly explored. Here the pharmacokinetics and pharmacodynamics of chronic intermittent (consequently, peak VPA concentrations) and continuous VPA administration were directly compared in two rat models of epilepsy.
  
  
  METHODS
  Genetic Absence Epilepsy Rats from Strasbourg (GAERS) received a single acute bolus of VPA (100 mg/kg intravenously) combined with electroencephalography (EEG) and/or blood sampling for 180 min post-injection. GAERS and epileptic rats post-kainic acid-induced status epilepticus were chronically infused intravenously (3-5 days, respectively) with (i) saline followed by in random order (ii) intermittent and (iii) continuous VPA (42 mg/kg/h), separated by two days of wash-out. Seizures were quantified using video-EEG monitoring and VPA levels measured in brain, cerebrospinal fluid and plasma.
  
  
  RESULTS
  Following acute VPA administration seizure suppression in GAERS persisted after plasma VPA levels became very low. Chronic intermittent and continuous VPA significantly suppressed seizures in both models (p<0.01) with no difference between administration regimens. In GAERS, the pattern of seizure suppression during intermittent treatment was constant, in contrast to the fluctuating VPA plasma and brain levels. There was discordance between the temporal pattern of plasma, brain VPA levels and seizure suppression efficacy in GAERS.
  
  
  CONCLUSIONS
  Administration regimes that result in fluctuating VPA blood levels achieve equivalent sustained seizure suppression as those that maintain steady mid-range concentrations.
authors.affiliation: The Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Royal Parade, Parkville 3050, VIC, Australia. stefanie.dedeurwaerdere@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Dedeurwaerdere
authors.forename: L
authors.initials: L
authors.lastname: van Raay
authors.forename: M J
authors.initials: MJ
authors.lastname: Morris
authors.forename: R C
authors.initials: RC
authors.lastname: Reed
authors.forename: R E
authors.initials: RE
authors.lastname: Hogan
authors.forename: T J
authors.initials: TJ
authors.lastname: O'Brien
mesh_terms: D000818:Animals; D004827:Epilepsy / Q000097:blood / Q000188:drug therapy / Q000235:genetics; D004832:Epilepsy, Absence / Q000097:blood* / Q000188:drug therapy* / Q000235:genetics; D005260:Female; D007260:Infusion Pumps; D008297:Male; D051381:Rats; D011922:Rats, Mutant Strains; D014635:Valproic Acid / Q000008:administration & dosage* / Q000097:blood*
chemical_list: D014635:Valproic Acid