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Treatment of childhood epilepsy with rectal valproate: case reports and pharmacokinetic study
O Kanazawa1, A Sengoku, I Kawai
1Department of Pediatrics, Utano National Hospital, Kyoto, Japan.
Insights
Rectal valproate (VPA) successfully treated status epilepticus in two children, showing rapid absorption similar to oral VPA. However, it is not ideal for initial status epilepticus treatment due to slower onset than IV diazepam.
Area of Science:
- Neurology
- Pharmacology
- Pediatrics
Background:
- Status epilepticus requires prompt and effective treatment.
- Valproate (VPA) is an established antiepileptic drug.
- Rectal administration offers an alternative route for drug delivery.
Observation:
- Two pediatric patients with status epilepticus were treated with rectal valproate (VPA).
- Seizure control was achieved in one patient without significant adverse events.
- Pharmacokinetic analysis via simulation suggested rapid early absorption of rectal VPA.
Findings:
- Rectal VPA demonstrated successful seizure control in children with status epilepticus.
- Early absorption of rectal VPA appears comparable to oral administration.
- Rectal VPA's onset of action is slower than intravenous diazepam (DZP).
Implications:
- Rectal valproate (VPA) may be a viable treatment option for status epilepticus, particularly when IV access is difficult.
- Further research is needed to establish optimal dosing and timing for rectal VPA in status epilepticus.
- While effective, rectal VPA is not recommended as a first-line therapy due to its delayed effect compared to intravenous medications.
Abstract:
Two children with status epilepticus were treated successfully by the rectal administration of valproate (VPA), and complete seizure control was obtained in one patient without severe side effects. In addition, there was no essential difference in pharmacokinetics between rectal and oral administration of VPA as determined by computerized simulation of plasma concentration data of VPA after rectal administration in two healthy adults or an epileptic child. Although these findings suggest that the early absorption of VPA within 30 minutes of rectal administration is slightly more rapid than that of oral administration, rectal VPA seems to be unsuitable for the first choice in the treatment of status epilepticus, since it has not so immediate effects as intravenous administration of DZP.