Sodium Valproate Group Research Articles

The Interactions of Resveratrol and Sodium Valproate on Penicillin-Induced Epilepsy Model: Electrophysiological and Molecular Study.

Epilepsy represents the most prevalent chronic neurological disease, characterized by spontaneous recurrent seizures. In experimental epilepsy models created by different methods, resveratrol has been demonstrated to reduce epileptiform activity and exhibit neuroprotective properties. A penicillin-induced model of epileptogenesis was used to investigate the effects of resveratrol and its combination with sodium valproate on epileptiform activity. The study design was an in vivo animal experimental study. Forty Wistar-albino rats were divided into five groups, each with eight rats. The groups are categorized as the saline group, penicillin group (only penicillin), resveratrol group, sodium valproate group, and resveratrol + sodium valproate group. ECoG recording was taken for 180min in all groups and statistically evaluated. GABAα1, mGluR1/mGluR5, NMDAR1 receptor expressions in the hippocampus, and S100B level in serum were measured. The spike frequency decreased statistically to 60th min in the sodium valproate group and 150th min in the resveratrol group. The spike frequency decreased statistically in the 20th min and later measurements of the recording in the resveratrol + sodium valproate group. GABAα1 receptor expression was increased in all groups compared to the penicillin group. mGluR1/mGluR5, NMDAR1 receptor expression was decreased in all groups compared to the penicillin group. Serum S100B level increased in all groups compared to the penicillin group. There was no statistically significant difference in epileptiform activity when resveratrol alone was administered in the penicillin-induced epilepsy model. Resveratrol co-administered with sodium valproate significantly reduced epileptiform activity. Co-administration of the sodium valproate + resveratrol group made the receptor level's highest GABAα1receptor expression at receptors.

Moringa oleifera hydroalcoholic leaf extracts mitigate valproate-induced oxidative status in the extraorbital lacrimal gland in a rat model

Dysfunction of the extraorbital lacrimal gland (ELG) can lead to loss of vision due to damage to the epithelium of cornea. The broad-spectrum anti-epileptic drug sodium valproate (SV) has numerous side effects. Moringa oleifera (M.oleifera) is widely used as a food and in folk medicine. The effects of orally administered SV and M. oleifera hydroalcoholic leaf extract on rat ELG were investigated in this study by analysing both antioxidant and oxidant parameters. Additionally, boron level and tissue factor (TF) activity were determined. Protein changes were detected by sodium dodecyl sulfate gel electrophoresis (SDS-PAGE). Significantly lower values of glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and total antioxidant status (TAS) were observed in the SV group compared to the control group. Treatment with Moringa extract significantly increased SOD, CAT and TAS values in the Moringa given SV group (SVM). While no significant differences were observed between the sialic acid values of the groups, lipid peroxidation (LPO), nitric oxide (NO) and total oxidant status (TOS) values were significantly elevated in the SV group compared to the control group. Due to the effect of Moringa extract, LPO, NO and TOS levels were significantly decreased in the SVM group compared to the SV group. TF activity was not meaningfully altered between groups. Compared to control rats, oxidative stress index (OSI) level significantly increased, whereas the boron level decreased in the SV group. Moringa extract treatment noticeably reduced OSI in the SVM group. According to SDS-PAGE, decreases in the density of protein bands with molecular weights of 51, 83, and 90 kDa were observed in SV given rats compared to the other groups. These decreases were reversed by the administration of Moringa extract. Moringa extract has shown protective properties arising from antioxidant potential, especially with its very low OSI value. Individuals undergoing SV treatment and having ELG complications might consider using Moringa extract to mitigate valproate induced damage.

Benefits of Combining Antiepileptic Drugs with Vitamin B12 on Redox Balance: Penicillin-Induced Experimental Epilepsy Model.

A combination of antiepileptic drugs and antioxidants may be an effective treatment by restoring the disrupted redox balance and reducing oxidative stress exposure to neurons. This study aims to evaluate the effects of valproate and vitamin B12 on oxidative stress in an experimental epilepsy model induced by penicillin when administered alone or in combination. 35 male Wistar rats were used in this study. The rats were divided into five groups, which were saline group, 1 mg/kg, 2 mg/kg Vit B12 groups and Sodium valproate group Sodium valproate + Vit B12 group. The epileptic activity was induced by 500 IU of penicillin injection. Sodium valproate and Vitamin B12 were administered 30 min after penicillin administration. Electrocorticogram recordings were taken for 2 hours post-treatment and serum parameters were assessed for oxidative stress markers using spectrophotometric method. There is statistically significant difference between the groups in total antioxidant status, total oxidant status, and oxidative stress index value (p=0.013; p˂0.001; p˂0.001, respectively). The valproate+vitamin B12 group showed elevated total thiol and native thiol levels, along with reduced disulphide levels, resulting in the lowest OSI value. These findings suggest the combined treatment effectively reduces oxidative stress. This study provides valuable insights into the antioxidant properties of valproate and vitamin B12, positioning them as potential agents for managing epilepsy. Understanding the efficacy and reliability of antioxidant strategies in epilepsy management could contribute significantly to advancements in epilepsy therapeutics.

Evaluation of Anti-epileptic Effect of Sinapis alba using Maximal Electroshock Seizure Model

Background: Epilepsy is a prevalent neurological disorder, prompting an ongoing quest for new therapeutic agents. Sinapis alba, commonly known as yellow mustard, has garnered interest for its potential medicinal properties. This study aimed to assess the anti-convulsant potential of Sinapis alba in rats. Methods: Wistar albino rats were categorized into 5 distinct experimental groups (six each) : a normal control, a disease control, a group administered Sinapis alba seed oil (200mg/kg body weight), another given sodium valproate (300mg/kg body weight), and a combination group receiving both Sinapis alba seed oil and sodium valproate (150mg/kg body weight each). Antioxidant markers were subsequently extracted from the brain samples, and cresyl violet staining was employed to discern pathological changes. Results: The findings revealed a significant diminution in the durations of flexion, clonic convulsion, and stupor in the test, standard, and combination groups in contrast with the disease control. Additionally, the duration of tonic hind limb extension (THLE) noted a substantial decrease in the Sinapis alba group, sodium valproate group, and combination group. Moreover, the administration of Sinapis alba seed oil led to an elevation in antioxidant levels and a concomitant reduction in lipid peroxide levels. Intriguingly, a synergistic effect on generalized tonic-clonic seizures was observed upon integrating mustard oil with sodium valproate. Conclusion: Our research suggests that Sinapis alba seed extract demonstrates promising anti-epileptic properties and stands as a potential supplementary drug for managing generalized tonic-clonic seizures.

A prospective study of thyroid profile in children aged 1 month to 12 years of age with newly diagnosed seizure disorder started on first line antiepileptic drugs

Background: The study's primary aim was to determine the variation in the thyroid profile status in children with newly diagnosed seizure disorders started on first-line antiepileptic drugs. In addition, this study compares the incidence of hypothyroidism secondary to phenytoin, phenobarbitone, valproate and carbamazepine. Methods: A total of 60 children with newly diagnosed seizure disorders belonging to the age group of 1 month to 12 years were enrolled in the study. The children were subjected to a detailed history and neurological examination, and serum levels of T3, T4, and thyroid-stimulating hormone (TSH) were tested. Results: In this study, out of 60 children, the clinical signs and symptoms of hypothyroidism were present only in one subject (1.7%), and the remaining 59 had no signs and symptoms of hypothyroidism. The mean TSH value increased from baseline 1.62±1.17 to 3 months 2.2±1.38 and 6 months 2.78±149 (p value<0.05%). The incidence of subclinical hypothyroidism among the phenytoin group (n=33) was 6.06%. Among the sodium valproate group (n=23), the incidence was 8.6%, and among the carbamazepine group (n=4), the incidence was 25%. Conclusions: Antiepileptic drugs can alter thyroid function tests. In this study, there was no overt hypothyroidism noted. But subclinical hypothyroidism was reported in subjects using phenytoin, valproate and carbamazepine.

An Open Comparative Randomized Study of the Effectiveness and Safety of Risperidone and Sodium Valproate for Secondary Prevention of Relapses of Bipolar Disorder I for 24 Months

Background: Comparative studies of monotherapy with second-generation antipsychotics (SGA) or mood stabilizers in the prevention therapy of Bipolar Disorder (BD) relapses, including those with psychotic symptoms, have not been conducted. Objective: a comparative study of the clinical features of risperidone (RIS) and sodium valproate (SV) in the prevention of relapses of BD. Patients and methods: 96 patients with BD-I (F31, ICD-10) were included, the duration of the disease was at least 2 years, the presence of at least two affective episodes (including psychotic symptoms). Design — open comparative randomized study. Study duration was 24 months. Patients were sequentially divided into groups of RIS and SV, comparable in the number of patients, clinical and sociodemographic indicators. The effectiveness of therapy was determined by comparing the indicators of the dynamics of the course of the disease for 2 years preceding the start of therapy (control period) and 2 years after the treatment beginning. Results: 14 patients dropped out in the first month after the start of therapy due to adverse events, 82 completed the study. The total duration of episodes decreased by 40-60%, the frequency — by 37.2% — 43.3% (p ≤ 0.05). The proportion of responders in the RIS group was 78.1%, SV — 68.3%. Complete suppression of phase formation was observed in 43.75% in the RIS group, in 10.7% — in the SV group. In the RIS group, the total duration of depressive episodes decreased by 38.3% (NS), manic by 65.2% (p ≤ 0.001), in the SV group — by 31.9% (NS) and by 52.9% (p ≤ 0.05), respectively. As to BD with psychotic symptoms, 85% of respondents were in the RIS group, and 50% were in the SV group. The average number of adverse events per patient in the group of SV was 0.9, RIS — 2.1. Conclusions: SV and RIS are comparable in effectiveness with better tolerance of SV. In patients with psychotic symptoms, the effectiveness of RIS was higher than that of SV.

Determination of plasma transcobalamin-II and zinc levels in newly-diagnosed and long-standing grand mal epileptic patients.

The changes of plasma transcobalamin-II (TCII) and Zinc (Zn) Levels in epileptic patients are not clearly understood. The aim of the current study was to evaluate the plasma contents of TCII and Zn levels in newly-diagnosed epileptic seizure patients, long-standing grand mal epileptic patients following treatment with sodium valproate and healthy control group. Thirty patients aged 36.76±12.91 years with newly-diagnosed and thirty long-standing grand mal epileptic patients aged 35.56 ±12.77 years were diagnosed based on the clinical symptoms. The control subjects were picked out from healthy individuals and matched to the patients, aged 36.30 ±12.80 years. Plasma Zn and TCN-2 was evaluated via spectrophotometry at 546 nm and 450 nm, respectively, using chimerical kits. Plasmalevel of TCII in the newly-diagnosed epileptic seizures patients and long-standing grand mal epileptic patients were significantly increased, compared to the healthy controls [14.89 ±3.24 and 21.84± 2.73 vs. 9.55±1.24, (n=30)], respectively.Plasma level of Zn was decreased in the newly-diagnosed epileptic seizure patients, while it was increased in long-standing grand mal epileptic patients compared to the control group [69.28± 6.41and 80.56 ±6.12 and vs.75.80±1.59, (n=30)], respectively. This study suggests that sodium valproate may disrupt the homeostatic balance of TCII and Zn, and cause abnormality of their serum level in newly-diagnosed epileptic seizure patients and long-standing grand mal epileptic patients. Further research is recommended to identify the underpinning for these changes.

Comparing Prophylactic Effect of Levetiracetam, Sodium Valproate, and Propranolol in Pediatric Migraine: A Randomized Clinical Trial.

Epidemiologic studies point to an increased prevalence of migraine in children in recent decades. Migraine treatment involves acute and prophylactic therapy. Recently, such anti-epileptic drugs as Levetiracetam have been used to treat adult migraines. The present study aimed to compare the efficacy of Levetiracetam, Sodium Valproate, and Propranolol in preventing migraine headaches in children. In this clinical trial, children with migraine were randomly divided into three groups. Each group consisted of 13 children. Two groups were treated with Propranolol and Sodium Valproate, respectively. Another group (the case) was treated with Levetiracetam. The patients were assessed based on headache score, PedMIDAS, and headache frequency before and three months after the intervention. Finally, the data was analyzed using descriptive and analytical statistical methods. Levetiracetam significantly reduced the headache severity (P=0.026), frequency (P=0.024), and PedMIDAS score (P=0.001) in children with migraine. However, no significant difference was found between the three groups. The percentage of patients who experienced pain relief was detected as 69.24%, 92.31%, and 30.76% in the Propranolol, Sodium Valproate, and Levetiracetam groups, respectively. This study concluded that Levetiracetam can be used as a migraine prophylaxis drug in children.

Evaluation of a Polyherbal Formulation on the Management of Migraine Headaches due to Functional Dyspepsia: A Double-Blind, Randomized, Placebo-Controlled Clinical Trial.

A holistic concept based on traditional Persian medicine (TPM) describes a headache with a gastrointestinal (GI) origin (gastric-headache). Although the neurological manifestations of this headache are similar to those of other headaches, its etiology is different. Considering its simultaneous effects on the brain and GI system, a formulation was designed based on this concept. This study aimed to determine the safety and efficacy of the designed formulation on migraine headache (MH) associated with functional dyspepsia (FD). A total of 75 diagnosed cases of MH patients with concurrent FD were randomly divided equally into 3 groups: (i) the polyherbal formulation, sodium valproate (VPA), and amitriptyline group, (ii) VPA, amitriptyline, and polyherbal formulation placebo group, and (iii) the polyherbal formulation and VPA placebo group. The primary outcomes, including frequency, duration, and severity of MH attacks, were measured at baseline and weeks 4, 8, and 12. However, secondary outcomes, including the Headache Impact Test 6 (HIT-6) Questionnaire and Parkman's score, were evaluated at baseline and end of treatment. The frequency, duration, and severity of migraine (P < 0.001 for all cases), HIT-6 (P < 0.001 for all cases), and FD (P < 0.001 for all cases) scores at the end of treatment showed a significant decrease in the 3 groups compared to the baseline. However, the differences in those variables between the 3 groups were not significant at the end of the study. The polyherbal formulation alone may improve the symptoms of migraine patients and other groups. This effect could be due to improving digestion and FD in migraine patients.

Comparison of the Hepatotoxicity of Carbamazepine, Sodium Valproate, Phenytoin, Lamotrigine, and Vigabatrin in a Rat Model

Background: Hepatotoxicity is one of the most important side effects of anticonvulsant drugs. This study compared the hepatotoxicity of sodium valproate, carbamazepine, phenytoin, lamotrigine, and vigabatrin in male rats. Methods: Based on the results, 56 rats were randomly divided into seven groups of eight and treated intraperitoneally for four weeks. Groups 1 and 2 received 500 mg/kg of carbamazepine and sodium valproate, and groups 3, 4, and 5 were injected with 200 mg/kg of phenytoin, 200 mg/kg lamotrigine, and 500 mg/kg vigabatrin, respectively. As control groups, the sixth and seventh received distilled water and sesame oil. Biochemical parameters such as alanine aminotransferase (ALT), aspartate transaminase (AST), and γ-glutamyl transferase (GGT) in the serum samples, as well as malondialdehyde (MDA) and glutathione (GSH) contents in liver homogenates, were measured at the end of the experiment. Results: MDA levels in carbamazepine and phenytoin groups were significantly higher than that in sodium valproate, lamotrigine, vigabatrin, and control groups (P&lt;0.05). GSH levels in carbamazepine and phenytoin groups were meaningfully higher compared to the groups that received sodium valproate (P&lt;0.05), vigabatrin, and control groups (P&lt;0.001). Based on the results, the GGT level in the carbamazepine group was remarkably higher in comparison with the other groups (P&lt;0.01). ALT and AST represented considerably higher levels in the phenytoin group compared to the vigabatrin, sodium valproate, and control groups (P&lt;0.01). Conclusion: Overall, carbamazepine-induced hepatotoxicity caused the most significant changes in GSH, GGT, and AST. The induction of hepatotoxicity with sodium valproate had the least effect on enzymes and was significantly different compared to carbamazepine and phenytoin groups. Because of no hepatic metabolism, the level of biomarkers did not demonstrate a considerable difference between vigabatrin and the control groups.

Intravenous ibuprofen versus sodium valproate in acute migraine attacks in the emergency department: A randomized clinical trial

ObjectiveSodium valproate and ibuprofen are drugs with known efficacy in the treatment of headache associated with acute migraine attacks. In this study, our aim was to compare the efficacy of these two drugs in the treatment of acute migraine attacks when administered as a single intravenous (IV) dose in the emergency department. Materials and methodThis study was designed as a prospective, randomized controlled, double-blinded study and included patients aged 18 to 65 years who presented to the emergency department with acute headache and met the criteria of ‘migraine without aura’ according to the International Classification of Headache Disorders. The patients were randomized into two groups and given a single dose of 800 mg sodium valproate or 800 mg ibuprofen in 150 mL of normal saline by IV infusion over five minutes. Changes in pain levels were assessed using the Numerical Rating Scale (NRS) for pain over a two-hour period. ResultsNinety-nine patients (49 patients in the sodium valproate group and 50 in the ibuprofen group) completed the trial, and their data were included in the statistical analysis. The mean decrease in the post-treatment delta NRS values was statistically significantly higher in the sodium valproate group than in the ibuprofen group. The mean differences were 1.69 [confidence interval (CI): 1.02–2.37, p<0.001], the mean difference between N0 and N2 was 3.61 (CI: 2.96-4.26, p < 0.001), the mean difference between N0 and N3 was 4.11 (CI: 3.54-4.67, p < 0.001), and the mean difference between N0 and N4 was 3.92 (CI: 3.67-4.46, p < 0.001). The number of patients who achieved the primary endpoint of pain relief was significantly higher in the sodium valproate group than in the ibuprofen group (p < 0.001). According to the Kaplan-Meier analysis showing the rates of reaching the targeted endpoint, there was a significant difference in the efficacy of the two-treatment group (χ2 = 79.98, CI: 80.35-99.65; p = 0.000).

Personality profile and therapeutic response to lithium carbonate and sodium valproate in mania with psychotic features.

Bipolar disorder is one of the major psychiatric disorders. Therefore, determining the factors that predict mood stabilizer response is important. This study aimed to investigate the relationship between personality profile and the response to lithium carbonate and sodium valproate in patients with psychotic mania. In this study, 50 patients with bipolar I disorder (manic episode with psychotic features) were randomly assigned to receive lithium carbonate (up to a serum level of 0.8-1.5 mEq/L) or sodium valproate (20 mg/kg). After stabilization of acute manic phase, Temperament and Character Inventory was completed by the patients themselves. Fifty subjects completed this study. The mean age ± SD of participants in the sodium valproate group and lithium carbonate group was 32.99 ± 9.94 and 30.73±7.94 years, respectively. The responders to sodium valproate had significantly higher scores in novelty seeking, harm avoidance (P = 0.003 and 0.004, respectively) and lower scores in persistence (P = 0.006) than the non-responders, but the responders to lithium carbonate did not have significantly different personality profiles. The results of the present study revealed that the personality profiles in the inpatients with psychotic mania are related to the responses to sodium valproate, but are irrelevant to the responses to lithium carbonate.

Comparison of the effect of continuous intravenous infusion of sodium valproate and midazolam on management of status epilepticus in children

Background and ObjectivesStatus epilepticus as a pediatric emergency requires rapid seizure control in order to prevent subsequent disabilities. Therefore, the present study was conducted to compare the efficacy and side effects of continuous intravenous infusion of sodium valproate versus midazolam as a third-line treatment of status epilepticus in children. MethodologyThis randomized clinical trial study included all children with convulsive and non-convulsive status epilepticus admitted to the pediatric intensive care unit (PICU) of the Bu-Ali Sina Hospital in Sari City (Mazandaran Province, Iran) who had not responded to first-line treatment with diazepam and second-line treatment with phenytoin or phenobarbital. They were consequently treated with continuous intravenous infusion of sodium valproate or midazolam to control persistent seizures. ResultsThe study comprised 70 patients who were randomly assigned to two equal groups of sodium valproate or midazolam treatment. The mean age of patients in group A (sodium valproate) and group B (midazolam) was 3.97 ± 3.33 and 3.84 ± 2.93 years, respectively. In the present study, the most common etiology of status epilepticus was remote symptomatic, accounting for 35% of cases in the two groups. Sodium valproate was effective in controlling status epilepticus in 91.4% of patients, while midazolam was found to be effective in 85.7% of patients (p > 0.05). Patients who received sodium valproate had shorter seizure duration after administration of the drug compared to those who received midazolam (p = 0.01). Eight patients in the midazolam group and two patients in the sodium valproate group were intubated (p = 0.023). The mean duration of stay in the PICU was 3.2 ± 1.4 and 5.6 ± 2.8 days in groups A and B, respectively, showing a significant difference (p = 0.001). ConclusionAccording to our findings, intravenous infusion of sodium valproate can be used as an effective and relatively safe treatment in children with all types of status epilepticus, especially in challenging situations such as lack of intensive care units or respiratory problems.

Analysis of the Clinical Effects of Sodium Valproate and Levetiracetam in the Treatment of Women with Epilepsy during Pregnancy.

Objective To explore the clinical effects of sodium valproate and levetiracetam in the treatment of women with epilepsy during pregnancy. Methods The clinical data of 124 women with epilepsy during pregnancy who received monotherapy with antiepileptic drugs (AEDs) in our hospital from September 2017 to January 2020 were retrospectively analyzed. According to the type of medication taken by the patients, they were recorded as the sodium valproate group (the VPA group, n = 56) and the levetiracetam group (the LEV group, n = 68 cases). The effects and the maternal and infant outcomes after treatment were compared between the two groups. The neuron-specific enolase (NSE), cognitive function-related parameters (brain-derived neurotrophic factor (BDNF) and myelin basic protein (MBP)), and related inflammatory factors (tumor necrosis factor- (TNF-) α and interleukin- (IL-) 6) levels were compared between the two groups before and after treatment. Results After treatment, the total clinical effective rate of the LEV group was 91.18% higher than that of the VPA group 73.21%, and the frequency and duration of seizures were lower than those of the VPA group (P < 0.05). After treatment, the probability of gestational hypertension, depression during pregnancy, low-weight infants, and neonatal deformities in the LEV group was lower than that in the VPA group (P < 0.05). After treatment, the levels of NSE, MBP, TNF-α, and IL-6 in the two groups decreased, and the levels of BDNF increased, and the LEV group changed significantly compared with the VPA group (P < 0.05). Conclusion Compared with sodium valproate monotherapy, levetiracetam is more effective in controlling seizures and improving maternal and infant outcomes in women with epilepsy during pregnancy and can effectively regulate their neurological and cognitive functions and reduce the serum inflammation factor level.

Evaluation of the Possible Protective Role of Ginger on Sodium Valproate Induced Hepatotoxicity in Adult Male Albino Rat: A Biochemical, Histological, And Immunohistochemical Study

Background: Sodium valproate (SVP) is a widely prescribed treatment for epilepsy and other neurological diseases. However, liver injury is a harmful side effect related to its usage. Oxidative stress, inflammation, and fibrosis seem to play a major role in SVP-induced hepatotoxicity. Aim of the work: This work aimed, for the first time, to study the possible protective mechanisms of ginger (GN) in modulating the hepatotoxic effects of SVP in albino rats. Material and methods: A total of 24 Sprague-Dawley adult male rats (180g - 220g) were divided into equal four groups: Group1 (control): received normal saline by gavage. Group2 (GN): received ginger (200mg/kg/day). Group3 (SVP): received SVP (300mg/kg/day). Group4 (GN+SVP): received combined ginger (200mg/kg/day) and SVP (300mg/kg/day).All medications were administrated dailyfor 14 days by gavage. At the assigned time the animals were sacrificed, the blood and tissue samples were collected and processed for biochemical, histological, and immunohistochemical studies. Result: SVP treatment induced a significant increase in alanine transaminase, aspartate transaminase, and Malondialdehyde (ALT, AST, and MDA respectively), together with a significant reduction in the antioxidant enzyme Glutathione (GHS) indicated hepatic oxidative stress damage. Histological examination revealed loss of the normal hepatic architecture, extensive fibrosis identified by Masson's trichrome staining. Moreover, the SVP group showed a significant increase in tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) Immunohistochemical expression. Co-treatment with GN significantly reversed the previous changes in the GN+SVP group. Conclusion: In conclusion, ginger has hepatoprotective activity due to its anti-oxidant, anti-inflammation, and anti-fibrotic potentials.

Intravenous Sodium Valproate Versus Dexamethasone Evaluation for Migraine Headache Pain Control in Acute Setting: A Randomized, Controlled, Double-Blind Study

Introduction: Migraine is a common disease in the emergency department (ED), which is capable of imposing limitations on people’s activity and imposing a high cost on the government. There are a lot of common treatments for migraine. In numerous studies, sodium valproate is included, among other treatments. This Study designed for efficacy evaluation of Sodium Valproate versus Dexamethasone in acute migraine headache pain control. Method: A controlled clinical trial has been established for ED patients with compliant of acute migraine headaches. 108 patients were included and categorized into two groups based on a randomized schedule: one with 1200 mg sodium valproate and another with 8 mg dexamethasone in 150 mL normal saline, which was IV infused in 10 minutes. As a primary outcome, pain visual analog scale (VAS) score was determined and compared on arrival and minutes 30, 60 and 120 after intervention, and as a secondary outcome, the percentage of rescue from headache through medication and sustainability of freedom and relief from headache were determined and compared between the two groups. Results: The mean decline of pain VAS score (0–10) in the sodium valproate group was 2.33 SD (1.74) and 3.49 SD (2.56), and in the dexamethasone group, it was 2.20 SD (1.86) and 3.30 SD (2.45) in the first and second hours after intervention, respectively. In each group, they are statistically significant (P &lt; 0.05), even though there was no statistically significant difference between the two groups of study (P &gt; 0.05). In terms of need for rescue medication, in the sodium valproate group, 30/54 (55.6%) people and in the dexamethasone group, 33/54 (61.1%) people used the medication; however, there were no statistically significant differences found between the two groups (P &gt; 0.05). Conclusion: Probably it can be concluded that there is no statistically significant difference between the efficacy of 1200 mg IV sodium valproate compared and 8 mg IV dexamethasone in reducing acute migraine headache Keywords: Sodium valproate, dexamethasone, acute migraine, pain control.

Protective Effect of Mito-TEMPO on Sodium Valproate-Induced Hepatotoxicity in Mice

Valproic acid is a broad-spectrum anticonvulsant drug that is also useful for other diseases such as bipolar disorder and migraines. The most important side effect of this drug is hepatotoxicity. Oxidative stress and mitochondrial dysfunction play a role in the pathogenesis of liver toxicity of valproic acid. Mito-TEMPO is an antioxidant-based compound, which is selectively accumulated in mitochondria. The effects of its mitochondrial protection against oxidative damage in various pathologies, such as liver damage, have been observed. The aim of this study was to evaluate the protective effect of Mito-TEMPO on liver toxicity induced by sodium valproate in mice. Animals were divided into five groups and treated intraperitoneally over a 4-week period. Group 1 received normal saline, served as vehicle control, group 2 treated with 12.5 mg/kg of sodium valproate, group 3 was treated with 1 mg/kg of Mito-TEMPO, group 4 received both sodium valproate (12.5 mg/kg) and Mito-TEMPO (1 mg/kg), and group 5 received sodium valproate (12.5 mg/kg), and vitamin E (5 mg/kg) served as a positive control. At the end of the experiment, blood samples were collected by cardiac puncture, and all the animals were killed under ether anesthesia. Biochemical parameters including AST, ALT, ALP, and GGT in serum samples and glutathione (GSH) and malondialdehyde (MDA) contents in liver homogenates were determined. The findings of this study showed that the activity of AST and ALT were significantly lower in the sodium valproate+Mito-TEMPO treated animals as compared to the sodium valproate group (group 2). Furthermore, Mito-TEMPO was able to recover glutathione content (GSH) of liver tissue. The effect of Mito-TEMPO on the activity of ALP and GGT and serum level of MDA was not significant. Taken collectively, Mito-TEMPO has a protective role in sodium valproate hepatotoxicity. Considering the present results, further studies, in view of the potential therapeutic properties of Mito-TEMPO in improving liver damage caused by the use of valproic acid, may lead to the clinical applications of Mito-TEMPO in the treatment of liver disease.

Sodium Valproate versus Propranolol in Chronic Migraine Prophylaxis

Background: There is a need for effective, well tolerated and affordable drug for chronic migraine prophylaxis in low socioeconomic countries.&#x0D; Objective: To study the efficacy and safety of propranolol and sodium valproate (a food and drug administration approved and widely used treatment for prevention of migraine) as a prophylactic treatment in chronic migraine (CM) patients and to compare their efficacy and safety to each other.&#x0D; Methods: In this single center, open labeled clinical trial, 40 patients with CM were subdivided into two group: group 1 (n=20) treated with propranolol and group 2 (n=20) treated with sodium valproate. Patients maintained headache diaries over a 1-month baseline period and a 6- month active study period. The evaluation of the treatment was done after 3 and 6 months of the initiation of the treatment. The efficacy measures were evaluation of monthly attacks frequency and attacks severity using VAS of pain (visual analogue scale. Disability and impact of migraine were evaluated using Migraine assessment disability scale (MIDAS) and Headache Impact Test (HIT-6). Throughout the study, patients were monitored for any symptoms or signs of adverse effects.&#x0D; Results: Of 40 patients participated in this study (mean age, 33.48; females 72.5%). At the 6th month, the study was completed by 27 patients (propranolol; n=14 and sodium valproate; n=13). Between 55 and 62% of both groups reported more than 50% reduction in monthly attacks frequency. In both groups, there was significant reduction of VAS of pain scores. Both groups showed significant improvement of HIT-6 and MIDAS scores. Before the start of treatment, 85% to 100% of patients in both groups had severe MIDAS and HIT-6 scores. At the end of the study, only 35.7% of propranolol group and 30.8 of sodium valproate group showed severe MIDAS scores and 50% of propranolol group and 40% of sodium valproate group reported severe HIT-6 scores. 55% (n=11) of patients in propranolol reported AEs related to treatment compared to 75% (n=15) in the sodium valproate group. A higher proportion of patients discontinued the treatment because of AEs in Na valproate group compared to sodium valproate group with no statistically significant difference in between (20% vs. 5%, respectively).&#x0D; Conclusions: Propranolol and sodium valproate demonstrated similar efficacy and tolerability in the prophylactic treatment of CM.

Alpha-lipoic acid ameliorates sodium valproate-induced liver injury in mice.

Aim:This study examines the effect of alpha-lipoic acid (ALA) on sodium valproate-induced liver injury through histological features of mice liver tissue.Materials and Methods:Mice were divided into three groups; (1) vehicle group, (2) sodium valproate group, and (3) sodium valproate-ALA group. The vehicle group was injected with saline intraperitoneal (i.p.) for 28 days. The sodium valproate group was injected with sodium valproate 300 mg/kg, i.p. daily for 2 weeks, after which the vehicle was administered daily until day 28. The sodium valproate-ALA group was injected with sodium valproate 300 mg/kg daily for 2 weeks before the administration of ALA 100 mg/kg i.p. until day 28. The mice were euthanized, and the liver was extracted for histopathological examination.Results:Histopathological examination of the liver section of the vehicle group showed a normal structure of the liver. Two weeks after the administration of sodium valproate, histopathological examination showed an abnormal structure of the liver, with necrotic appearance and inflammatory cells. Moreover, treatment with ALA after the administration of sodium valproate notably ameliorated hepatic histopathological lesions and the liver structure corresponded to a normal liver structure.Conclusion:ALA ameliorates sodium valproate-induced liver injury in mice.

Long-term safety, tolerability, and efficacy of magnesium valproate versus sodium valproate in acute seizures

Objectives: To evaluate the safety, tolerability and efficacy of magnesium valproate and sodium valproate as monotherapies in patients with epilepsy in China.Methods: We recruited patients admitted with seizures over a two-year period. All patients underwent early neurological assessments, electroencephalogram testing, and neuroimaging. The treatments received at baseline and at one year of follow-up were compared.Results: In total, 175 patients were included. The retention rates of the magnesium valproate and sodium valproate treatments were 73.1% and 64.2%, respectively. The main cause of discontinuation was the development of intolerable adverse events. The retention rate and total effective rate in the magnesium valproate group were significantly higher than those in the sodium valproate group (73.1% and 70.2% versus 64.2% and 47.2%, respectively). The safety endpoints included 120 patients (magnesium valproate: n = 67; sodium valproate: n = 53). The incidence of adverse events in the magnesium valproate group was significantly lower than that in the sodium valproate group (30% versus 51%).Conclusions: Magnesium valproate treatment shows favorable safety and tolerability and is associated with markedly improved seizure control. Ideally, future large, prospective, randomized, and double-blind studies are needed to confirm these findings.