Intravenous Valproate for Status Epilepticus or Acute Repetitive Seizures

Intravenous valproate and phenytoin were similarly effective in adults, but the relevance of these results to the real-world setting is unclear.

The optimal approach for the treatment of status epilepticus (SE) or acute repetitive seizures (ARS) remains undefined. Intravenous phenytoin plus a benzodiazepine is standard therapy, but serious adverse effects can occur. These researchers compared the efficacy and tolerability of intravenous valproate and phenytoin as first-line treatment in 74 adults, 27 with SE and 47 with ARS, admitted consecutively to one emergency department during a 3-year period. Patients were randomized 2:1 to open-label valproate or phenytoin. Lack of seizure control after the initial study drug prompted use of the other study drug; subsequent nonresponse was treated with intravenous midazolam. The primary endpoint was clinical seizure cessation with no rescue m…

Reviewing Author

Daniel H. Lowenstein, MD