Treatment of status epilepticus and acute repetitive seizures with i.v. valproic acid vs phenytoin

Gilad, Ronit; Izkovitz, N.; Dabby, Ron; Rapoport, A.; Sadeh, Menachem; Weller, Boaz; Lampl, Yair

doi:10.1111/j.1600-0404.2008.01097.x

Cited by 114 publications

(98 citation statements)

References 14 publications

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“…Valproic acid had higher efficacy than phenytoin in one study (valproic acid, 66%, vs phenytoin, 42%; p = 0.046) (27) and was similar to phenytoin in the other (valproic acid, 87.8%, vs phenytoin, 88%) (26).…”

Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

“…Class III trials support efficacy and safety of valproic acid as first-line therapy (26,27), second-line therapy (31,32), and refractory therapy (66). Evidence for use of levetiracetam and lacosamide is limited to retrospective studies (67)(68)(69)(70)(71)(72).…”

Section: Future Directionsmentioning

confidence: 99%

“…Nine RCTs (three class I [22][23][24], one class II [25], and five class III [26][27][28][29][30]) addressed the efficacy of initial therapy. The 1998 Veteran's Affairs status epilepticus study was a multicenter randomized comparison of four different IV treatments: lorazepam (0.1 mg/kg), diazepam (0.15 mg/kg) followed by phenytoin (18 mg/kg), phenobarbital (18 mg/kg), and phenytoin alone (18 mg/kg) in adults with either overt or subtle status epilepticus (22).…”

Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

“…The five open-label class III initial therapy RCTs examined the efficacy of IV valproic acid (n = 2) (26,27), IV phenytoin (n = 2) (26,27), IV phenobarbital (n = 1) (29), IV diazepam plus phenytoin (n = 1) (29), IV levetiracetam (n = 1) (30), rectal diazepam (n = 1) (28), and IV lorazepam (n = 1) (30) in cohorts ranging from 9 to 41 patients. Valproic acid had higher efficacy than phenytoin in one study (valproic acid, 66%, vs phenytoin, 42%; p = 0.046) (27) and was similar to phenytoin in the other (valproic acid, 87.8%, vs phenytoin, 88%) (26).…”

Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

See 3 more Smart Citations

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

Glauser

Shinnar

Gloss³

et al. 2016

Epilepsy Curr

945

937

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CONTEXT: The optimal pharmacologic treatment for early convulsive status epilepticus is unclear. OBJECTIVE: To analyze efficacy, tolerability and safety data for anticonvulsant treatment of children and adults with convulsive status epilepticus and use this analysis to develop an evidence-based treatment algorithm. DATA SOURCES: Structured literature review using MEDLINE, Embase, Current Contents, and Cochrane library supplemented with article reference lists. STUDY SELECTION: Randomized controlled trials of anticonvulsant treatment for seizures lasting longer than 5 minutes. DATA EXTRACTION: Individual studies were rated using predefined criteria and these results were used to form recommendations, conclusions, and an evidence-based treatment algorithm. RESULTS: A total of 38 randomized controlled trials were identified, rated and contributed to the assessment. Only four trials were considered to have class I evidence of efficacy. Two studies were rated as class II and the remaining 32 were judged to have class III evidence. In adults with convulsive status epilepticus, intramuscular midazolam, intravenous lorazepam, intravenous diazepam and intravenous phenobarbital are established as efficacious as initial therapy (Level A). Intramuscular midazolam has superior effectiveness compared to intravenous lorazepam in adults with convulsive status epilepticus without established intravenous access (Level A). In children, intravenous lorazepam and intravenous diazepam are established as efficacious at stopping seizures lasting at least 5 minutes (Level A) while rectal diazepam, intramuscular midazolam, intranasal midazolam, and buccal midazolam are probably effective (Level B). No significant difference in effectiveness has been demonstrated between intravenous lorazepam and intravenous diazepam in adults or children with convulsive status epilepticus (Level A). Respiratory and cardiac symptoms are the most commonly encountered treatment-emergent adverse events associated with intravenous anticonvulsant drug administration in adults with convulsive status epilepticus (Level A). The rate of respiratory depression in patients with convulsive status epilepticus treated with benzodiazepines is lower than in patients with convul-

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Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

Section: Future Directionsmentioning

confidence: 99%

Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

Section: Q1 Which Anticonvulsants Are Efficacious As Initial and Submentioning

confidence: 99%

See 2 more Smart Citations

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

Glauser

Shinnar

Gloss³

et al. 2016

Epilepsy Curr

945

937

View full text Add to dashboard Cite

show abstract

“…36 Experience in SE is limited to small series. [36][37][38] In one series valproic acid was as effective in terminating SE as phenytoin. 39 Since valproate appears to have few cardiovascular effects, it may serve as a second-line drug that could be administered in recalcitrant SE prior to giving phenobarbital or initiating treatment for RSE.…”

Section: Second-line Medicationsmentioning

confidence: 99%

Status Epilepticus

Manno

2011

The Neurohospitalist

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Status epilepticus is a neurological emergency that is commonly encountered by the neurohospitalist. Successful treatment depends upon the recognition of prolonged seizure activity and the acute mobilization of available resources. Pharmacologic treatment regimens have been shown to decrease the time needed for successful control of seizures and have provided for the rapid administration of anticonvulsant medications. Treatment strategies have evolved so that clinicians can administer effective doses of medication by whatever routes of administration are immediately available. Traditional algorithms for the treatment of status epilepticus have used a stepwise approach to the administration of first-, second-, and third-order medications. More recent options have included aggressive anesthetic doses of medications while second-line medications are being titrated.

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Minimizing the Adverse effects of Epilepsy Therapies: Principles and Practice

Louis

2015

Epilepsy and the Interictal State

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Treatment of status epilepticus and acute repetitive seizures with i.v. valproic acid vs phenytoin

Abstract: VPA i.v. seems to be effective and well tolerated in adult patients with SE or ARS.

Cited by 114 publications

References 14 publications

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

Status Epilepticus

Minimizing the Adverse effects of Epilepsy Therapies: Principles and Practice

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