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Submitted: 28 November 2012
HERDIN Record #: R04A-DLSHSI-12112717181469

Intravenous Valproic Acid for control of status epilepticus in children: A meta analysis .

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Background: Status epilepticus is a medical emergency that needs immediate intervention.In the recent years, intravenous valproic acid has gained popularity for use in status epilepticus because of its equal efficacy and better safety profile compared to previous first line medications.
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Objectives: The primary objective is to establish the efficacy and safety of intravenous valproic acid in controlling status epilepticus in children aged 3 months to 18 years old.
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Search Strategy: A search was done in Medline, Pubmed, Cochrane, EMBASE, CENTRAL using the Mesh terms "status epilepticus", " prolonged seizures", " intravenous valproic acid", "valproic acid", "intravenous sodium valproate", "sodium valproate" and "children" for trials published from 1990-2009. Cross reference with bibiliogaphies, search for unpublished and local trials was done.
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Selection Criteria: Randomized controlled trials on the use of intravenous valproic acid versus another anti epileptic drug for control of status epilepticus in children ages 3 months to 18 years old were included.
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Data Collection and Analysis: Data were extracted independently and quality of included trials were assessed independently using standard forms. Additional inquiries was sought through communication with the study authors. Data was analyzed using Review Manager 5.
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Main Results: A total of 3 randomized controlled trials and population of 208 subjects were included. Intravenous valproic acid is 76.63% effective in controlling status epilepticus in children. (OR= 0.49, 95% CI 0.23 to 1.04, p=0.06) Loading dose of 20-40mg/kg and infusion rates of 2-5 mg/kg/min was used. Its safety is well tolerated with a statistically significant freedom from adverse events of respiratory depression (OR=0.10, 95% CI 0.02 to 0.04) and hypotension (OR= 0.06, 95% CI 0.01 to 0.32). However, elevation in liver enzymes was thrice more likely in treated patients. (0R 3.08, 95% CI 0.71 to 13.29) Breakthrough seizures for 6 hours from initiaton of treatment was 5% less likely for the valproic acid treated children. (OR 0.95, 95% CI 0.41 to 2.16) Neurologic outcome and mortality did not differ between the two groups. Reviewer's
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Conclusion: Intravenous valproic acid is effective for control of status epilepticus in children and may be a better alternative for those at high risk for adverse events with the first line drugs and for refractory cases. A larger randomized controlled trial is needed to recommend its use as a first line agent.

Objectives

The primary objective is to establish the efficacy and safety of intravenous valproic acid in controlling status epilepticus in children aged 3 months to 18 years old.

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3/F Room 6301 De La Salle Angelo King Medical Research Center 2009- A.4 Fulltext Print Format