Valproic acid as adjuvant treatment for convulsive status epilepticus: a randomised clinical trial

Author:

Sharshar Tarek,Porcher Raphaël,Asfar Pierre,Grimaldi Lamiae,Jabot Julien,Argaud Laurent,Lebert Christine,Bollaert Pierre-Edouard,Harlay Marie Line,Chillet Patrick,Maury Eric,Santoli Francois,Blanc Pascal,Sonneville Romain,Vu Dinh Chuyen,Rohaut Benjamin,Mazeraud Aurelien,Alvarez Jean-Claude,Navarro Vincent,Clair Bernard,Outin Hervé,Argaud Laurent,Azabou Eric,Beloncle François,Ben-Hadj Omar,Blanc Pascal,Bollaert Pierre-Edouard,Bolgert Francis,Bouadma Lila,Chillet Patrick,Clair Bernard,Corne Philippe,Clere-Jehl Raphaël,Cour Martin,Crespel Arielle,Déiler Véronique,Dellamonica Jean,Demeret Sophie,Harley Marie-Line,Henry-Lagarrigue Matthieu,Jabot Julien,Heming Nicholas,Hernu Romain,Kouatchet Achille,Lebert Christine,Lerolle Nicolas,Maury Eric,Letrou Sophie,Mazeraud Aurélien,Mercat Alain,Mortaza Satar,Mourvillier Bruno,Outin Hervé,Paugham-Burtz Catherine,Pierrot Marc,Provent Marion,Rohaut Benjamin,De La Salle Sylvie,Santoli François,Schenk Maleka,Siami Shidasp,Souday Vincent,Sharshar Tarek,Sonneville Romain,Timsit Jean-François,Thuong Marie,Weiss Nicolas,

Abstract

AbstractBackgroundGeneralised convulsive status epilepticus (GCSE) is a medical emergency. Guidelines recommend a stepwise strategy of benzodiazepines followed by a second-line anti-seizure medicine (ASM). However, GCSE is uncontrolled in 20–40% patients and is associated with protracted hospitalisation, disability, and mortality. The objective was to determine whether valproic acid (VPA) as complementary treatment to the stepwise strategy improves the outcomes of patients with de novo established GCSE.MethodsThis was a multicentre, double-blind, randomised controlled trial in 244 adults admitted to intensive care units for GCSE in 16 French hospitals between 2013 and 2018. Patients received standard care of benzodiazepine and a second-line ASM (except VPA). Intervention patients received a 30 mg/kg VPA loading dose, then a 1 mg/kg/h 12 h infusion, whilst the placebo group received an identical intravenous administration of 0.9% saline as a bolus and continuous infusion. Primary outcome was proportion of patients discharged from hospital by day 15. The secondary outcomes were seizure control, adverse events, and cognition at day 90.ResultsA total of 126 (52%) and 118 (48%) patients were included in the VPA and placebo groups. 224 (93%) and 227 (93%) received a first-line and a second-line ASM before VPA or placebo infusion. There was no between-group difference for patients hospital-discharged at day 15 [VPA, 77 (61%)versusplacebo, 72 (61%), adjusted relative risk 1.04; 95% confidence interval (0.89–1.19);p = 0.58]. There were no between-group differences for secondary outcomes.ConclusionsVPA added to the recommended strategy for adult GCSE is well tolerated but did not increase the proportion of patients hospital-discharged by day 15.Trial registrationNo. NCT01791868 (ClinicalTrials.gov registry), registered: 15 February 2012.

Publisher

Springer Science and Business Media LLC

Subject

Critical Care and Intensive Care Medicine

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Customized Proteinaceous Nanoformulation for In Vivo Chemical Reprogramming;Advanced Materials;2024-05-15

2. Editorial: The neurologist's guide to the ICU galaxy;Current Opinion in Critical Care;2024-03-07

3. Status epilepticus: what's new for the intensivist;Current Opinion in Critical Care;2024-02-13

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3