Abstracts

RATIONALE: An intravenous formulation of valproate is available for achieving high levels in a short period of time. It may be a useful adjunct in the treatment of status epilepticus. METHODS: We reviewed pharmacy records of intravenous valproate administration at Henry Ford Hospital during a fifteen-month period from 11/98 to 2/00. After review of the medical records of these patients, we identified 12 patients (11 adult and 1 pediatric) treated for status epilepticus. RESULTS: Each of the 12 patients was in non-convulsive status epilepticus (9 partial and 3 atypical absence), and two were on chronic oral valproate prior to the onset of status epilepticus. All nine patients in partial status epilepticus had failed to respond to treatment with lorazepam and/or phenytoin, and six out of the nine responded to iv valproate. All three patients with atypical absence status epilepticus responded to iv valproate. In total, nine patients responded to iv valproate and avoided subsequent intubation, and three patients required pentobarbital. Two patients (one responder and one non-responder to valproate) died of cardiac arrest four weeks later due to pre-existing conditions. Three patients (including one on chronic valproate) developed thrombocytopenia with platelet counts less than 100 k/?L (minimum 35 k/?L) within 48 hours of iv valproate infusion. The platelet count in all three patients returned to baseline in 3 to 4 days after cessation of iv valproate, and one of those patients was discharged on oral valproate with a platelet count of >120 k/?L. CONCLUSIONS: Intravenous valproate may be a useful adjunct in the management of selected cases of non-convulsive status epilepticus because of its broad spectrum of efficacy and lack of respiratory suppression. It may be particularly useful if the physician wishes to avoid intubation. The efficacy of iv valproate in status epilepticus needs further investigation with controlled clinical trials.