Published June 30, 2023 | Version https://impactfactor.org/PDF/IJPCR/15/IJPCR,Vol15,Issue6,Article159.pdf

Comparative Analysis between Valproate and Phenytoin in Convulsive Status Epilepticus in Pediatric Population

  • 1. Assistant Professor, Department of Pediatrics, Vedantaa Institute of Medical Sciences, Palghar, Maharashtra

Description

Introduction: Status epilepticus (SE) is a common neurological emergency in children that calls for prompt and aggressive treatment and occasionally presents a therapeutic challenge to the attending physician. The main anti-epileptic impact is brought about by voltage-dependent sodium channels being inhibited. Phenytoin reduces sodium input into neurons, which reduces excitability, by acting on the intracellular portion of the ion channel. Since action depends on both use and concentration, it should start as soon as an effective concentration is attained. The most frequent neurologic emergency, generalized convulsive status epilepticus (GCSE), accounts for 1% to 2% of all visits to the emergency room. Any seizure lasting more than 30 minutes is considered to be in the status epilepticus (SE), regardless of whether awareness is affected or whether subsequent seizures occur without a break in consciousness. Aims and Objectives: To compare the efficacy between valproate and phenytoin during status epilepticus among children. Methods: A randomized double-controlled study was conducted on 100 pediatric patients who visited the outpatient department. Injections of sodium valproate (Valprol, 5 mL per 500 mg, Intas Pharmaceuticals, India), and sodium phenytoin (Ciroton, 2 mL per 100 mg, Ciron Pharmaceuticals, India) were used. The baseline characteristics were determined before the drug treatment and the outcome assessment factors were assessed after the drug treatment of each group at prescribed dosage and duration. required statistical analysis was conducted. Results: The patients were divided equally into 2 groups phenytoin and valproate. Males are more in valproate group (60%). Generalized convulsive seizure are mostly seen in valproate group (90%) compared to phenytoin group (76%). Hypocalcemia is seen mostly in phenytoin (12%) than valproate (10%). The primary outcome is seen in 90% of phenytoin group and 82% in valproate group. The phenytoin group had a greater rate of additional medicine to control the seizure after control of the seizure by study drug (21.3%) compared to the valproate group (11.6%). Conclusion: This study has demonstrated that phenytoin and valproate are equally effective in reducing seizure frequency in the treatment of paediatric convulsive status epilepticus

 

 

 

Abstract (English)

Introduction: Status epilepticus (SE) is a common neurological emergency in children that calls for prompt and aggressive treatment and occasionally presents a therapeutic challenge to the attending physician. The main anti-epileptic impact is brought about by voltage-dependent sodium channels being inhibited. Phenytoin reduces sodium input into neurons, which reduces excitability, by acting on the intracellular portion of the ion channel. Since action depends on both use and concentration, it should start as soon as an effective concentration is attained. The most frequent neurologic emergency, generalized convulsive status epilepticus (GCSE), accounts for 1% to 2% of all visits to the emergency room. Any seizure lasting more than 30 minutes is considered to be in the status epilepticus (SE), regardless of whether awareness is affected or whether subsequent seizures occur without a break in consciousness. Aims and Objectives: To compare the efficacy between valproate and phenytoin during status epilepticus among children. Methods: A randomized double-controlled study was conducted on 100 pediatric patients who visited the outpatient department. Injections of sodium valproate (Valprol, 5 mL per 500 mg, Intas Pharmaceuticals, India), and sodium phenytoin (Ciroton, 2 mL per 100 mg, Ciron Pharmaceuticals, India) were used. The baseline characteristics were determined before the drug treatment and the outcome assessment factors were assessed after the drug treatment of each group at prescribed dosage and duration. required statistical analysis was conducted. Results: The patients were divided equally into 2 groups phenytoin and valproate. Males are more in valproate group (60%). Generalized convulsive seizure are mostly seen in valproate group (90%) compared to phenytoin group (76%). Hypocalcemia is seen mostly in phenytoin (12%) than valproate (10%). The primary outcome is seen in 90% of phenytoin group and 82% in valproate group. The phenytoin group had a greater rate of additional medicine to control the seizure after control of the seizure by study drug (21.3%) compared to the valproate group (11.6%). Conclusion: This study has demonstrated that phenytoin and valproate are equally effective in reducing seizure frequency in the treatment of paediatric convulsive status epilepticus

 

 

 

Files

IJPCR,Vol15,Issue6,Article159.pdf

Files (311.1 kB)

Name Size Download all
md5:57d1c8cf15ee753286386107d355977e
311.1 kB Preview Download

Additional details

Dates

Accepted
2023-06-05

References

  • 1. McAbee GN, Wark JE. A practical approach to uncomplicated seizures in children. Am Fam Physician. 2000; 62:1109–16.2. Vining EP. Pediatric seizures. Emerg Med Clin North Am. 1994;12:973–88. 3. Singhi S, Singhi P, Dass R. Status epilepticus: emergency management. Indian J Pediatr. 2003;70(Suppl 1): S17–22. 4. Hanhan UA, Fiallos MR, Orlowski JP. Status epilepticus. Pediatr Clin North Am. 2001;48:683–94. 5. Treatment of convulsive status epilepticus. Recommendations of the epilepsy foundation of America's Working Group on status epilepticus. JAMA. 1993;270:854–9. 6. Tullu MS, Mukhija V. Status epilepticus. In: Gupte S, editor. Recent Advances in Pediatrics. Special Volume 14. New Delhi: Jaypee Brothers; 2004. p. 1531. 7. Berg AT, Shinnar S, Testa FM, et al. Status epilepticus after the initial diagnosis of epilepsy in children. Neurology. 2004;63:1027–34. 8. Raj D, Gulati S, Lodha R. Status epilepticus. Indian J Pediatr. 2011;78:219–26. 9. Gulati S, Kalra V, Sridhar MR. Status epilepticus in Indian children in a tertiary care center. Indian J Pediatr. 2005;72:105–8. 10. Verrotti A, Ambrosi M, Pavone P, Striano P. Pediatric status epilepticus: Improved management with new drug therapies? Expert Opin Pharmacother. 2017;18:789–98. 11. Huff JS, Morris DL, Kothari RU, Gibbs MA. Emergency department management of patients with seizures: a multicenter study. Acad Emerg Med. 2001;8(6):622–628. 12. Capovilla G, Beccaria F, Beghi E et al. Treatment of convulsive status epilepticus in childhood: Recommendations of the Italian League Against Epilepsy. Epilepsia. 2013;54(suppl 7):23–34. 13. DeLorenzo RJ, Garnett LK, Towne AR et al. Comparison of status epilepticus with prolonged seizure episodes lasting from 10 to 29 minutes. Epilepsia. 1999;40(2):164–169. 14. Jenssen S, Gracely EJ, Sperling MR. How long do most seizures last? A systematic comparison of seizures recorded in the epilepsy monitoring unit. Epilepsia. 2006;47(9):1499–1503. 15. Lowenstein DH, Bleck T, Macdonald RL. It's time to revise the definition of status epilepticus. Epilepsia. 1999;40(1):120–122. 16. Shinnar S, Berg AT, Moshe SL, Shinnar R. How long do new-onset seizures in children last? Ann Neurol. 2001;49(5):659–664. 17. Wasterlain CG, Chen JW. Definition and classification of status epilepticus. In: Westerlain CG, Treiman DM, editors. Status Epilepticus. Cambridge, MA: MIT Press; 2006. pp. 11–16. 18. Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990;40(5suppl 2):13–23. 19. DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults, and the elderly. Epilepsia. 1992;33(suppl 4):S15–S25. 20. Malamiri RA, Ghaempanah M, Khosroshahi N, Nikkhah A, Bavarian B, Ashrafi MR. Efficacy and safety of intravenous sodium valproate versus phenobarbital in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children: a randomised trial. Eur J Paediatr Neurol. 2012 Sep;16(5):536-41. 21. Misra, U. K., Kalita, J., & Patel, R. Sodium valproate vs phenytoin in status epilepticus: a pilot study. Neurology, 2006;67(2): 340-342. 22. Vignesh, V., Rameshkumar, R. & Mahadevan, S. Comparison of Phenytoin, Valproate and Levetiracetam in Pediatric Convulsive Status Epilepticus: A Randomized Double-blind Controlled Clinical Trial. Indian Pediatr. 2020; 57: 222–227. 23. Agarwal, P., Kumar, N., Chandra, R., Gupta, G., Antony, A. R., & Garg, N. Randomized study of intravenousvalproate and phenytoin in status epilepticus. Seizure, 2007;16(6): 527– 532. 24. Malamiri, R. A., Ghaempanah, M., Khosroshahi, N., Nikkhah, A., Bavarian, B., & Ashrafi, M. R. Efficacy and safety of intravenous sodium valproate versus phenobarbital in controlling convulsive status epilepticus and acute prolonged convulsive seizures in children: A randomised trial. European Journal of Paediatric Neurology, 2012;16(5): 536– 541.