Abstracts

Intravenous VPA has recently been approved for treatment of benzodiazepine-resistant status epilepticus (SE) in Norway, as the first country in Europe. We have started a prospective registration of the effect of i.v. VPA in SE and serial attacks (SA) from 8 Norwegian hospitals. Data have been obtained from the first 26 adult patients, 15 women and 11 men, treated with i.v. VPA for benzodiazepine-resistant SE/SA. The protocol suggested a VPA loading dose of 25 mg/kg over 30 min, followed by continuous infusion of 100 mg/hour for 24 hours. 16 patients were diagnosed with SE, 10 with SA. 14 had generalised tonic-clonic while 8 had complex-partial seizures as their main SE/SA seizure type. 4 had mixed or other type of seizures. Median VPA loading dose was 1200 mg (range 200-2514). Median time to treatment of SE/SA for all patients was 2.5 h (range 0.3-72 h). For patients with complex partial SE/SA, median time to start of VPA treatment was 2,4 h (range 0-72). Effect, defined as the lack of need of anaesthesia (barbiturates or propofol), showed that VPA was effective in 18 of 26 cases (69 %). Of the 8 cases requiring anaesthesia, 4 had a significant delay before starting treatment (24 to 72 hours). Moderate hypotension during loading dose infusion was seen in one patient, but corrected easily with i.v. saline without complications. Otherwise, no side-effects were reported. VPA seems to be safe and effective in the treatment of benzodiazepine-resistant SE/SA. Lack of effect may be related to delayed treatment. In addition, some of the patients also got a too low loading dose. Our preliminary results suggest that VPA is as effective as fos-phenytoin which is used as an alternative drug in Norway. However, randomised and blinded studies are needed.