Abstracts

RATIONALE: Staus epilepticus(SE) remains a treatment challenge. Valproate has proven antiseizure properties. Intravenous valproate (IV VPA) does not produce marked sedation, respiratory depression, or cardiac arrhythmias as seen with some agents. This side effect profile has lead to more investigation as an acute therapy for seizures. Further efficacy and tolerability data are needed in the treatment of SE. METHODS: 28 cases of SE (19 adults, 9 children) were prospectively identified from the VCU/MCV SE database of the Greater Richmond Metropolitan Area from 8/97 through 5/00 who received IV VPA for SE treatment. Charts were reviewed for SE type, etiology, SE duration, concommitant AEDs, prior VPA use, dosage, outcome, infusion complications. RESULTS: We had 23 patients(17 adults, 6 pediatric), 5 generalized nonconvulsive, 11 partial, 2 myoclonic, 5 GTC treated with IV VPA for SE. 17/23 (11 adults, 6 pediatric) improved to IV VPA. All had been previously treated with a benzodiazepine (BZD), and 16 had received (fos)phenytoin. In 5 further cases, patients had SE interupted by a short-acting BZD(4 cases) or ended spontaneously (1 case) and recurrrence was prevented by IV VPA infusion. Loading doses ranged from single doses of 500-2600mg in adults, with total loading of 1000-3600mg. In pediatric patients single loading doses of 10-45mg/kg were used with total loading of 10-60mg/kg. Intravenous infusion occurred over various rates, typically 20-60 minutes in adults and between 1-9mg/kg/min in pediatric patients. No infusion complications were noted, no hypotension or episodes of respiratory depression in non-intubated patients. CONCLUSIONS: IV VPA is effective in the treatment of SE in both adults and children. IV VPA is well tolerated at high loading doses and fast infusions. IV VPA offers advantages over more sedating agents and does not produce hypotension nor respiratory depression. Further study with formalized protocols with regard to dosing and infusion are warranted.