The following is the summary of “Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial” published in the January 2023 issue of Critical care by Sharshar, et al.

The onset of a condition known as generalized convulsive status epilepticus (GCSE) should always be treated as an immediate crisis. An orderly progression from benzodiazepines to a second-line anti-seizure medicine (ASM) is advocated in the guidelines. However, uncontrolled GCSE is linked to longer hospital stays, disability, and mortality in 20-40% of patients. The purpose of this study was to evaluate the efficacy of valproic acid (VPA) in improving outcomes for patients with de novo-developed GCSE when used in conjunction with the stepwise method.

This randomized, controlled experiment was conducted across 16 hospitals in France between 2013 and 2018, and it involved 244 adults who had been admitted to intensive care units for GCSE. Patients were given benzodiazepines and an ASM as part of the normal treatment protocol (except VPA). Patients in the intervention group were given an initial loading dosage of 30 mg/kg VPA followed by an infusion rate of 1 mg/kg/h for 12 hours, whereas those in the placebo group were given an equal bolus and infusion rateThe primary outcome was patients’ ability to leave the hospital on day 15 primary outcome. Secondary objectives were to control seizures, adverse events, and cognitive function at day 90. Among the total number of patients, 126 (52% of the total) were assigned to the VPA group, while 118 (48%) were assigned to the placebo group. 

A first-line ASM was given to 224 (93%), and a second-line ASM was given to 227 (93%) before VPA or placebo was infused. Patients released from the hospital on day 15 showed no significant difference between the VPA and placebo groups (77 vs. 72, 61%, adjusted relative risk 1.04; 95% confidence interval 0.89-1.19; P=0.58). No significant differences in secondary outcomes were seen across groups. Adding VPA to the standard treatment for adult GCSE is safe. However, it did not result in earlier hospital discharge for more patients.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-022-04292-7