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Valproate versus diazepam for generalized convulsive status epilepticus: a pilot study.

W B Chen¹, R Gao, Y Y Su

¹Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.

European Journal of Neurology

|May 12, 2011

Summary

Intravenous valproate (VPA) and diazepam (DZP) are effective second-line treatments for status epilepticus (SE). VPA showed better safety, avoiding respiratory depression and hypotension seen with DZP.

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Area of Science:

Neurology
Clinical Pharmacology

Background:

Status epilepticus (SE) management after first-line treatment failure requires evidence-based alternatives, especially when phenytoin is unavailable.
Intravenous (IV) valproate (VPA) and continuous diazepam (DZP) infusion have not been directly compared in adults with SE.

Purpose of the Study:

To evaluate the relative efficacy and safety of IV VPA versus continuous DZP infusion as second-line anticonvulsants for generalized convulsive status epilepticus (GCSE).

Main Methods:

A prospective randomized controlled trial involving 66 adult patients with GCSE after first-line treatment failure.
Patients were randomized to receive either IV VPA or continuous DZP infusion.
Primary outcome was effective seizure control; side effects and time to regaining consciousness were also assessed.

Main Results:

Seizure control rates were similar: 50% for VPA and 56% for DZP (P=0.652).
VPA group had no respiratory depression, hypotension, or hepatic dysfunction; DZP group experienced 5.5% requiring ventilation and 5.5% developing hypotension.
Time to regaining consciousness was shorter with VPA (3 hours) compared to DZP (13 hours), though not statistically significant (P=0.057).
Viral encephalitis and prolonged GCSE duration were risk factors for drug resistance.

Conclusions:

Both IV VPA and continuous DZP infusion are effective second-line treatments for GCSE.
IV VPA demonstrated a favorable safety profile, being free from respiratory depression and hypotension observed with DZP.
While overall outcome parameters were not significantly different, VPA's safety profile suggests it as a preferred alternative.