Abstracts

Phenytoin is the usual option when intravenous antiepileptic drugs are needed in emergency room procedures, brain surgery or at the end of video-EEG monitoring sessions. On the other hand, side effects to phenytoin infusion are frequent and are often severe. We have been using intravenous valproate intraoperatively as an alternative in patients with previous severe allergic reactions to phenytoin and phenobarbital and at the end of video-EEG sessions.
Two patients with previous severe allergic reactions to phenytoin and phenobarbital who needed to be submitted to epilepsy surgery received intravenous valproate boli (25mg/kg). One was submitted to corticoamygdalohippocampectomy and the other to callosal section. Seven patients submitted to prolonged video-EEG recording after drug withdrawal received boli of intravenous valproate at the end of the session. Video-EEG recordings were continued for a couple of hours after valproate infusion.
The procedure went uneventful in both patients submitted to surgery who received intravenous valproate; there were no seizures in the postoperative period. Intravenous valproate was as effective as intravenous phenytoin in immediately stopping the seizures at the end of video-EEG sessions; no significant side effect was noted. In one patient who did not respond to intravenous phenytoin, partial status epilepticus remitted after intravenous valproate.
Intravenous valproate is an useful alternative to phenytoin when intravenous antiepileptic drugs are needed in a non-operative setting. Platelet function and number seem not to be affected by the acute 25mg/kg bolus used in our patients submitted to surgery; the latter should be further studied in a larger surgical population.
[Supported by: Sao Paulo Secretary of Health]