Phenobarbital versus valproate for generalized convulsive status epilepticus in adults. An updated systematic review...

Status epilepticus (SE) is a neurological emergency with significant mortality and morbidity with generalized convulsive SE (GCSE) being the most prevalent. A meta-analysis reported an overall mortality rate of 15.9 % in adults and 3.6 % in children, with variations based on etiology, age, and treatment response. We compare phenobarbital with valproate for the treatment of GCSE.

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. An electronic search was performed on PubMed, Embase, and Cochrane from inception to March 2025. In addition, unpublished clinical trials were searched for on the "ClinicalTrials.gov" website. Three authors independently screened the titles and abstracts of all retrieved articles and removed those not fulfilling the inclusion criteria. We only included randomized controlled trials (RCTs) in our meta-analysis.

After screening 3706 articles, seven studies were selected for inclusion after removing the duplicates, and assessing the titles and abstracts. The meta-analysis involved a total pool of 475 participants divided into two groups: 232 patients in the Phenobarbital group, and 243 patients in the Valproate group. The use of Phenobarbital was associated with a more effective control of GSCE compared to Valproate (RR = 1.20, 95 % CI 1.04-1.39, P = 0.01, I2 =80 %), however phenobarbital group were more likely to experience adverse effects (RR = 2.49, 95 % CI 1.53-4.04, P = 0.002, I2 = 0 %) than valproate group.

In conclusion, phenobarbital is more successful than valproate at controlling GSCE, although phenobarbital group showed more negative adverse effects.