Abstracts

RATIONALE: Intravenous Valproate is a recent addition to the anti-epileptic drugs available for parenteral use in the United States. Acute treatment of seizures is the condition where parenteral anti-epileptic drugs may be most useful. Phenobarbital undergoes less rapid penetration of the blood-brain barrier and may be associated with sedation and respiratory depression. Hypotension and cardiac arrhythmia are associated with Phenytoin, in addition to the risk of injection site complication. Fosphenytoin circumvents the adverse effects of phenytoin but still has limited value in the treatment of myoclonic, atonic, and absence seizures. Valproate is a broad spectrum anti-epileptic drug and its intravenous form may facilitate administration of loading doses in the emergent treatment of seizures.
METHODS: To date, twenty five children ( eighteen with status epilepticus, seven with acute repetitive seizures ) were given intravenous Valproate loading of 25 mg/kg; diluted with D5W ( a 1:1 ratio ). The rate of infusion was 3mg/kg/min. Ages were 1 month to 15 years. Heart rate and blood pressure were taken before and after infusion. Levels were drawn after 1 hour of infusion.
RESULTS: Rapid intravenous loading of Valproate stopped the status epilepticus within 20 minutes. All the patients regained baseline mental status within 1 hour of cessation of their status epilepticus. There were no further seizures noted in the group with acute repetitive seizures after intravenous loading with Valproate.There were no significant changes in blood pressure or heart rate in both groups of patients. Only one patient in the status epilepticus group complained of transient tremors.The Vaproate level ranged from 90-120 ug/ml in both groups.
CONCLUSIONS: Intravenous Valproate loading is safe and efficacious in the treatment of acute seizure emergencies in the pediatric population.
Support: Abbott Pharmaceutical.
Disclosure: Grant - Abbott Pharmaceutical.