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Comparative study of efficacy and safety of intravenous sodium valproate with intravenous phenytoin sodium in the treatment of status epilepticus in children

Background Status Epilepticus (SE) is a common paediatric neurological emergency that requires immediate and aggressive management. The standard treatment of status epilepticus includes use of diazepam, midazolam, phenytoin sodium/phenobarbitone, diazepam infusion in sequential order. Unfortunately the current therapies mentioned above have considerable adverse effects. There was a continued search for alternative drug. We found out that intravenous (IV) sodium valproate is safe and effective in controlling paediatric SE.

Objective Compare efficacy and safety of intravenous sodium valproate with intravenous phenytoin sodium in the treatment of status epilepticus in children.

Methods This prospective comparative study was done over a period of two years. Children admitted to paediatric intensive care unit who satisfy inclusion criteria were included in the study. Thirty two subjects were enrolled. The subjects were randomized. 17 patients in VPA group received intravenous (IV) valproate in dose of 30 mg/kgas loading dose followed by additional 10 mg/kg if not controlled and fifteen patients in PHT group received intravenous (IV) phenytoin in the doses of 20 mg/kg and an additional 10 mg/kg if not controlled. Children were clinically monitored for adverse events. Treatment was considered successful if seizures were controlled within 20 minutes.

Results IV valproate was successful in 82.4% and IV phenytoin in 80% with P>0.05. In a cross over, out of 3 uncontrolled patients in PHT group, none of the children got controlled with VPA as 2nd choice. However in VPA group, out of 3 uncontrolled patients, one got controlled with phenytoin as 2nd choice. Recurrence was 2.5 times more with phenytoin (3/7) than valproate (2/7) with P=0.209.

Conclusions It was observed that intravenous sodium valproate is as effective as intravenous phenytoin in treatment of paediatric status epilepticus. The drug was tolerated well with no clinically observed adverse effects.