Stellenwert von intravenösem valproat beim status epilepticus

The therapy of status epilepticus (SE) is still empirically proven, there is only few evidence from controlled trials. Nevertheless, with a mortality of up to 25% according to a recent prospective trial and an estimated incidence of 50 millions a year worldwide, SE represents a current therapeutic problem. Clearly perceptible side effects of the drugs that are actually available for the therapy of SE limit their use. In the following, the clinical experience with utilization of intravenous valproate (VPA), which is available in Germany since autumn of 1996, for the treatment of SE shall be shown. As known from oral therapy, valproate is effective against a broad spectrum of focal and generalized seizures. Experimental as well as clinical data show an excellent tolerability of the substance, serious side effects have been described only casuistically. With respect to efficacy, in literature and in an own analysis of 102 patients success rates of about 80% are found. Intravenous VPA seems to have a comparable efficacy to phenytoin. There are varying recommendations concerning the dosage of VPA. In most cases, a initial bolus is recommended to interrupt seizure activity, followed by an infusion to maintain seizure freedom. The recommended dosage of the initial bolus is between 900 mg and 2400 mg, the dosage of the following infusion between 2400 mg and 9600 mg. The experiences that have been made so far with intravenous valproate are altogether very promising. They suggest that it could become an interesting alternative to classical antiepileptic drugs in the therapy of SE. Disadvantages are up to now mainly the lack of sufficient experience and missing controlled trials. Advantages are in contrast extensive experiences with oral application, an excellent tolerability and an easy switch to oral maintenance therapy.