Safety and Efficacy of Intravenous Valproate in Pediatric Status Epilepticus and Acute Repetitive Seizures

• Published in: Epilepsia (Copenhagen) Vol. 44; no. 5; pp. 724 - 726
• Main Authors: Yu, Kian‐Ti, Mills, Sandra, Thompson, Nanora, Cunanan, Cedric
• Format: Journal Article
• Language: English
• Published: Boston, MA, USA Blackwell Science Inc 01-05-2003; Blackwell
• Subjects: Acute Disease; Acute repetitive seizures; Acute seizure; Adolescent; Anticonvulsants - administration & dosage; Anticonvulsants - adverse effects; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Emergencies; Epilepsy - drug therapy; Female; Humans; Infant; Infusions, Intravenous; Intravenous valproate; Male; Medical sciences; Neuropharmacology; Pediatric; Pharmacology. Drug treatments; Seizures - drug therapy; Status epilepticus; Status Epilepticus - drug therapy; Treatment Outcome; Valproic Acid - administration & dosage; Valproic Acid - adverse effects; Prognosis; Intravenous administration; Toxicity; Epilepsy; Anticonvulsant; Intravenous valproate-Pediatric-Status epilepticus-Acute repetitive seizures-Acute seizure-Emergencies; Neurological disorder; Child; Status epilepticus; Repetition; Human; Nervous system diseases; 4-Aminobutyrate transaminase; Enzyme; Transferases; Enzyme inhibitor; Valproic acid; Cerebral disorder; Chemotherapy; Treatment; Convulsion; Transaminases; Central nervous system disease; Pharmacokinetics; Therapeutic protocol
• DOI: 10.1046/j.1528-1157.2003.41302.x
• EISSN: 1528-1167
• ISSN: 0013-9580

Purpose: To evaluate the safety and efficacy of intravenous valproate (VPA) loading in children with status epilepticus (SE) or acute repetitive seizures.
Methods: Retrospective review was performed on 40 pediatric patients with intravenous VPA loading. Patients were classified into two groups: SE (n = 18) and acute repetitive seizures (n = 22). Thirty‐one patients were VPA naïve and received a full loading dose of 25 mg/kg; nine had subtherapeutic plasma VPA levels and received a partial loading dose. Average infusion rate was 2.8 mg/kg/min. Heart rate and blood pressure were measured before, during, and after infusion.
Results: Intravenous VPA loading stopped seizures in 18 patients with SE within 20 min. All 18 patients regained baseline mental status within 1 h of seizure cessation. Among 22 patients with acute repetitive seizures, only one had further seizures after VPA infusion. One patient in the SE group complained of transient tremors. No significant changes in blood pressure or heart rate were found in either group. Postinfusion plasma VPA levels ranged from 51 to 138 μg/ml (mean ± SD = 88 ± 21.5 μg/ml).
Conclusions: Intravenous VPA loading is safe and effective for treating acute seizure emergencies in children.