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Published on: April 5, 2011
IV Valproate in generalized convulsive status epilepticus: a systematic review
F Brigo1, M Storti, A Del Felice
1Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy. dr.francescobrigo@gmail.com
European Journal of Neurology
|December 21, 2011
Summary
Intravenous valproate (IV VPA) shows better tolerability than phenytoin (PHT) for treating generalized convulsive status epilepticus (GCSE). Efficacy in seizure cessation and freedom at 24 hours was similar between IV VPA and PHT.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Generalized convulsive status epilepticus (GCSE) is a medical emergency requiring prompt treatment.
- Intravenous valproate (IV VPA) is an antiepileptic drug used in managing GCSE.
- Evidence synthesis from randomized controlled trials (RCTs) is needed to evaluate IV VPA's efficacy and safety.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous valproate (IV VPA) in treating generalized convulsive status epilepticus (GCSE).
- To synthesize available evidence from randomized controlled trials (RCTs) comparing IV VPA with other treatments for GCSE.
Main Methods:
- Systematic search of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for RCTs on IV VPA for GCSE.
- Inclusion of studies with no age restriction for patients with GCSE.
- Data extraction and meta-analysis of outcomes including clinical seizure cessation, seizure freedom at 24 hours, and adverse effects.
Main Results:
- Five RCTs met the inclusion criteria.
- Meta-analysis of IV VPA versus phenytoin (PHT) showed a statistically lower risk of adverse effects for IV VPA (RR 0.31, 95% CI 0.12-0.85).
- No statistically significant differences were found in GCSE cessation (RR 1.31, 95% CI 0.93-1.84) or seizure freedom at 24 hours (RR 0.96, 95% CI 0.88-1.06) between IV VPA and PHT.
Conclusions:
- Intravenous valproate (IV VPA) demonstrates better tolerability compared to phenytoin (PHT) in the treatment of GCSE.
- Efficacy in terms of seizure cessation and 24-hour seizure freedom appears comparable between IV VPA and PHT.
- Further rigorous RCTs are required to definitively establish the efficacy and tolerability of IV VPA in clinical practice for GCSE.
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