Efficacy Of Intravenous Valproate Research Articles

Efficacy and Safety of Intravenous Sodium Valproate in Convulsive Status Epilepticus in Children in Shahid Sadoughi Hospital

Efficacy and Safety of Intravenous Sodium Valproate in Convulsive Status Epilepticus in Children in Shahid Sadoughi Hospital

Depacon in the acute treatment of mania

Study objectives: Anticonvulsants are a first-line treatment for acute mania and offer a safer and more efficacious treatment than lithium. Oral loading with valproic acid is US Food and Drug Administration approved. Valproate, the intravenous form of valproic acid, reaches peak serum concentration 4 times faster than valproic acid but is primarily used for acute seizure treatment. There is minimal literature on intravenous valproate in treating acute mania. Methods: We describe a pilot study designed to test the safety and efficacy of intravenous valproate in treating manic patients presenting to the emergency department (ED). Five subjects, aged 21 to 50 years, who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for mania, were enrolled between May 1999 and April 2002. On admission to the ED, consent, blood tests, and physical examination were obtained. Psychiatric testing, including the clinical global impression score (CGI), brief psychotic rating scale (BPRS), and Young's mania rating scale (YMRS), were administered before and 1, 2, and 24 hours after valproate infusion. A loading dose of 1,200 mg valproate was given over a 1-hour period at initial testing. Results: No adverse effects were noted. Mean scores before infusion were consistent with moderate to severe mania (CGI=4.8, BPRS=32.6, and YMRS=21.2). One hour after infusion, scores were reduced 12.5%, 7.4%, and 15.1%, respectively. The 2-hour interval showed further improvement from baseline of 29.2%, 16.6%, and 21.7%. Twenty-four hour follow-up for 4 of 5 patients showed a 37.5%, 17.2%, and 30.2% decrease from baseline. Two of the 5 patients were treated as outpatients, with transition to oral valproate. Conclusion: Notable decreases in illness severity rapidly occurred in all manic subjects receiving intravenous valproic acid. However, because of low enrollment, no statistical significance can be inferred. Also, we must caution that decreased symptomology could be due to sedation rather than reduction of the manic episode. Typically, manic patients require hospitalization; intravenous loading of valproate may decrease hospital stay or possibly alleviate the need for admission. This pilot study would suggest that further inquiry is warranted.

Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures.

To evaluate the safety and efficacy of intravenous valproate (VPA) loading in children with status epilepticus (SE) or acute repetitive seizures. 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. 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 microg/ml (mean +/- SD = 88 +/- 21.5 microg/ml). Intravenous VPA loading is safe and effective for treating acute seizure emergencies in children.