title: Valproate versus diazepam for generalized convulsive status epilepticus: a pilot study.
abstract: OBJECTIVE
  Evidence-based data to guide the management of status epilepticus (SE) after failure of primary treatment are still scarce and the alternate needs to be found when phenytoin (PHT) is not available or contraindicated. Comparison of intravenous (IV) valproate (VPA) and diazepam (DZP) infusion has not been conducted in adults with SE. This prospective randomized controlled trial is thus designed to evaluate the relative efficacy and safety of IV VPA and continuous DZP infusion as second-line anticonvulsants.
  
  
  METHODS
  After failure of first-line anticonvulsants treatment, patients with generalized convulsive status epilepticus (GCSE) were randomized to receive either IV VPA or continuous DZP infusion. Primary outcome was the proportion of patients with effective control. Side effects were also evaluated.
  
  
  RESULTS
  There were 66 cases enrolled, with the mean age of 41 ± 21 years. Seizure was controlled in 56% (20/36) of the DZP group and 50% (15/30) of the VPA group (P = 0.652). No patient in the VPA group developed respiratory depression, hypotension, or hepatic dysfunction, whereas in the DZP group, 5.5% required ventilation and 5.5% developed hypotension. Time (hour) for regaining consciousness after control was near-significantly longer in the DZP group [13(3.15-21.5)] than in the VPA group [3(0.75-11)] (P = 0.057). Virus encephalitis and long duration of GCSE were independent risk factors of drug resistance.
  
  
  CONCLUSIONS
  Both IV VPA and continuous DZP infusion are effective second-line anticonvulsants for GCSE. IV VPA was well tolerated and free of respiratory depression and hypotension, which may develop in the DZP group. Outcome parameters were not significantly different between groups.
authors.affiliation: Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.
authors.forename: W B
authors.initials: WB
authors.lastname: Chen
authors.forename: R
authors.initials: R
authors.lastname: Gao
authors.forename: Y Y
authors.initials: YY
authors.lastname: Su
authors.forename: J W
authors.initials: JW
authors.lastname: Zhao
authors.forename: Y Z
authors.initials: YZ
authors.lastname: Zhang
authors.forename: L
authors.initials: L
authors.lastname: Wang
authors.forename: Y
authors.initials: Y
authors.lastname: Ren
authors.forename: C Q
authors.initials: CQ
authors.lastname: Fan
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002561:Cerebrovascular Disorders / Q000150:complications; D003975:Diazepam / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D004569:Electroencephalography; D004630:Emergencies; D018792:Encephalitis, Viral / Q000150:complications; D004827:Epilepsy / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012131:Respiratory Insufficiency / Q000139:chemically induced; D013226:Status Epilepticus / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome; D014635:Valproic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid; D003975:Diazepam