A comparative study to assess the efficacy of i.v valproate and i.v phenytoin as first line therapy in childhood status epilepticus
Journal Title: INTERNATIONAL JOURNAL OF CURRENT RESEARCH IN MEDICAL SCIENCES - Year 2017, Vol 3, Issue 3
Abstract
Background: Status epilepticus (SE) implies prolonged single seizure or multiple episodes of seizures lasting more than 30 min without regaining consciousness in between. Status epilepticus is a medical emergency and should be treated promptly to prevent morbidity and mortality. The pharmacological treatment is strictly a step up type starting from initial drug and going to higher drug sequentially in case of failure of previous drug to control seizure. Most of the existing medications are associated with several disadvantages and unfavorable side-effects. Sodium valproate is an anti-epileptic drug with several applications in different types of seizures such as absence, tonic–clonic, and myoclonic seizures and it is also effective in several types of partial epilepsy. Numerous studies have shown that intravenous sodium valproate may be a potential antiepileptic drug(AED) to be effective in SE. It may be used as a first-line AED in SE with a good seizure control. Objectives: To compare the efficacy of i.v valproate versus i.v phenytoin as first line therapy in childhood status epilepticus in age group 1-15 yrs and to observe the incidence of various specific side effects of valproate and phenytoin. Other objectives were to observe any correlation of seizure control to patient characteristics like age, gender, diagnosis, seizure type, duration of seizure prior to admission and family/previous history of seizure disorder. Methods: This prospective study was conducted on 100 children admitted with status epilepticus in the department of Pediatrics, Government Medical College, Amritsar. Children were divided into 2 groups A and B and were alternatively given loading dose (20mg/kg) of i.v valproate and i.v phenytoin respectively after initial short acting benzodiazepine midazolam (0.2 mg/kg) i.v / i.m as rescue medication. The efficacy of the two drugs were compared in terms of the following parameters: 1. Time to control seizure. 2. Number of patients having seizure recurrence. 3. Extent of cardiorespiratory compromise, if any in terms of hypotension and respiratory depression. 4. Drug specific adverse effects were also noticed. 5. Duration of hospital stay: included discharged, expired, as well as patients who left against medical advice. Also any correlation of the seizure control to patient characteristics like age, gender, seizure etiology, seizure type , duration of seizure prior to admission and previous/family history of seizure disorder were studied. Results: The mean time of seizure control in valproate group was 6.30 ± 1.02 mins and in phenytoin group was 6.80 ± 0.94 mins. Seizure recurred in 8% of patients in valproate group and 20% of patients in phenytoin group. No patient in either valproate or phenytoin group had significant cardiorespiratory compromise in the form of hypotension , respiratory depression or any drug specific adverse effects during the hospital stay. Conclusion: We found i.v valproate as more efficacious compared to i.v phenytoin as first line therapy in status epilepticus in children 1-15 yrs of age with regard to time taken to control seizure(p=0.044). . Since the oral drug of choice for long term use in various types of seizures nowadays is valproate, shifting from i.v to oral drug may be more convenient in case of valproate than in phenytoin. We found valproate to be superior and safe in our study and conclude that valproate can be used in suitable patients as first line therapy alternative to phenytoin in status epilepticus.
Authors and Affiliations
Simranpreet Singh, Palwinder Singh, Karnail Singh Mukhtiar Singh Pannu, N. S. Neki
Keywords
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- EP ID EP550098
- DOI 10.22192/ijcrms.2017.03.03.015
- Views 157
- Downloads 0
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