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Intravenous sodium valproate versus diazepam infusion for the control of refractory status epilepticus in children: a

Vishal Mehta1, Pratibha Singhi, Sunit Singhi

  • 1Department of Pediatrics, Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Journal of Child Neurology
|October 18, 2007
PubMed

Insights

Intravenous sodium valproate effectively controls refractory status epilepticus in children, offering a faster median control time than diazepam. This treatment avoids respiratory depression and hypotension, unlike diazepam infusion.

Area of Science:

  • Pediatric Neurology
  • Emergency Medicine
  • Clinical Pharmacology

Background:

  • Refractory status epilepticus (RSE) in children presents a critical medical emergency.
  • Diazepam infusion is a common treatment for RSE but carries significant risks.
  • Alternative, safer treatments for pediatric RSE are needed.

Purpose of the Study:

  • To compare the efficacy and safety of intravenous sodium valproate versus diazepam infusion for controlling RSE in children.
  • To evaluate the time to seizure control and adverse events associated with each treatment.

Main Methods:

  • An open-label, randomized controlled study.
  • Forty pediatric patients with RSE were randomized to receive either intravenous sodium valproate or diazepam infusion.
  • Efficacy (seizure control) and safety (adverse events) were assessed.

Main Results:

  • Seizure control was achieved in 80% of the valproate group and 85% of the diazepam group.
  • Median time to control RSE was significantly shorter with valproate (5 minutes) compared to diazepam (17 minutes; P < .001).
  • Valproate group had no cases of ventilation requirement or hypotension; diazepam group had 60% requiring ventilation and 50% developing hypotension. No liver function abnormalities were noted with valproate.

Conclusions:

  • Intravenous sodium valproate is an effective alternative to diazepam infusion for pediatric RSE.
  • Sodium valproate offers a faster seizure control and a superior safety profile, notably avoiding respiratory depression and hypotension.
  • Valproate demonstrates a favorable safety profile regarding liver function in this pediatric population.

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