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Open Access Research article

The efficacy of intravenous sodium valproate and phenytoin as the first-line treatment in status epilepticus: a comparison study

Somsak Tiamkao12*, Kittisak Sawanyawisuth1 and Alongkorn Chancharoen1

Author Affiliations

1 Department of Medicine, Faculty of Medicine, Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand

2 Department of Medicine, Faculty of Medicine, Khon Kaen University, 123 Mitraparp Road, Khon Kaen 40002, Thailand

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BMC Neurology 2013, 13:98  doi:10.1186/1471-2377-13-98

Published: 27 July 2013

Abstract

Background

Status epilepticus (SE) is a serious neurological condition and requires prompt treatment. Sodium valproate has been used to treat SE successfully but its role as the first-line antiepileptic drug (AED) is still controversial. This study evaluated the efficacy of intravenous sodium valproate to determine if it is non-inferior to intravenous phenytoin in SE treatment.

Methods

Patients diagnosed as SE during 2003–2010 who were of an age of more than 15 years and received either intravenous sodium valproate or intravenous phenytoin as the first-line treatment were enrolled. Clinical characteristics and outcomes of SE were recorded and analyzed. The differences of outcomes between sodium valproate and phenytoin group were determined by descriptive statistics.

Results

During the study period, there were 37 and 17 SE patients who received intravenous phenytoin and intravenous sodium valproate as the first-line treatment, respectively. All patients received diazepam 10 mg intravenously as a rescue medication before starting the antiepileptic agents if uncontrolled except one patient in the sodium valproate group. There were no significant differences between the phenytoin and sodium valproate groups in all outcome variables including numbers of patients with clinically-controlled seizures, non-dependent patients, time to seizure control, and duration of hospitalization, and death. No serious cardiovasculars event such as hypotension occurred in either group.

Conclusion

Intravenous sodium valproate is non-inferior to intravenous phenytoin as the first-line treatment in SE with no significant cardiovascular compromises.

Keywords:
Phenytoin; Sodium valproate; Efficacy; Status epilepticus; Comparison