Phenobarbital Versus Valproate for Generalized Convulsive Status Epilepticus
Study Details
Study Description
Brief Summary
Although generalized convulsive status epilepticus (GCSE) is a life-threatening emergency, evidence-based data to guide initial drug treatment choices are lacking in the Chinese population. The investigators conduct this prospective randomized controlled trial to evaluate the relative efficacy and safety of intravenous (IV) phenobarbital (PB) and valproate (VPA) in patients with GCSE.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
| Phase 2 |
Detailed Description
After the failure of first-line diazepam treatment, patients with GCSE are randomized to receive either IV PB (standard doses, low rate) or VPA (standard). Successful treatment is considered when clinical and electroencephalographic seizure activity ceases. Adverse events following treatment and the neurological outcomes at discharge and 3 months later are also evaluated.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Phenobarbital In the PB group, a loading dose of 20 mg/kg (may give an additional 10 mg/kg) begins at a rate of 50 mg/min followed by IV 100 mg q6 h. |
Drug: Phenobarbital
In the PB group, a loading dose of 20 mg/kg (may give an additional 10 mg/kg) begins at a rate of 50 mg/min followed by IV 100 mg q6 h.
Other Names:
|
| Experimental: Valproate In the VPA group, a loading dose of 30 mg/kg (may give an additional 15 mg/kg) begins at a rate of 3 mg/kg per min followed by a continuous infusion at a rate of 1-2 mg/kg per hour. |
Drug: Valproate
In the VPA group, a loading dose of 30 mg/kg (may give an additional 15 mg/kg) begins at a rate of 3 mg/kg per min followed by a continuous infusion at a rate of 1-2 mg/kg per hour.
Other Names:
|
Outcome Measures
Primary Outcome Measures
- Number of patients with effective seizure control [One hour after the end of the PB or VPA loading dose]
The primary study endpoint is the number of patients with effective seizure control, defined as a cessation of clinical and electroencephalographic seizure activity within 1 h after administration of the phenobarbital or valproate loading dose. Effective control of GCSE is assessed clinically by one certified neurologist and also confirmed with EEG by one certified electroencephalographer.
Secondary Outcome Measures
- Mortality of patients [at 30 days and at 3 months]
Neurologic outcome is assessed both at 30 days and at 3 months by one physician unaware of the therapeutic assignment through a phone interview or scheduled follow-up clinic visit. Mortality of each group is recorded at 30 days and at 3 months, respectively.
- Number of patients with post-SE symptomatic epilepsy [3 months]
Post-SE symptomatic epilepsy at 3 months is analyzed. It is defined as the occurrence of at least 2 unprovoked epileptic seizure occurring not earlier than 4 weeks after termination of SE in those without pre-existing epilepsy.
- The relapse rates of SE and nonconvulsive status epilepticus (NCSE) / nonconvulsive seizures (NCS) [in the first 24 h]
The investigators also record the relapse rates of SE and nonconvulsive status epilepticus (NCSE) / nonconvulsive seizures (NCS) in each group in the first 24 h.
Other Outcome Measures
- Number of Participants With Adverse Events [From the administration of PB or VPA to 1 week]
Adverse events are recorded as follows: systolic blood pressure lower than 90 mmHg, pulse lower than 50 beats/ min, arrhythmia (except supraventricular tachycardia), respiratory depression (arterial oxygen saturation below 90%, partial pressure of oxygen below 60 mmHg, or partial pressure of carbon dioxide above 60 mmHg), drug-induced liver disease (alanine aminotransferase or total bilirubin increase of more than twice the upper limit of the normal range), elevation of blood ammonia (more than twice the upper limit of the normal range), gastric motility insufficiency, bone marrow suppression (leukocytopenia, neutrocytopenia, thrombocytopenia or anemia), coagulation disorders, or drug-related sedation. The time to record adverse events is from the administration of PB or VPA to 1 week.
Eligibility Criteria
Criteria
Inclusion Criteria:
- All consecutive GCSE patients (after the failure of first-line diazepam treatment) who were admitted in the emergency room or neurocritical care unit in Xuanwu Hospital of Capital Medical University.
Exclusion Criteria:
-
Unstable vital signs, such as a systolic blood pressure of <90 mm Hg, a pulse of <60 beats per min, or an arterial blood oxygen saturation of <90%,
-
Liver dysfunction (alanine transaminase or total bilirubin of more than twice the normal upper limit),
-
Neurologic emergency requiring immediate surgical intervention,
-
Pregnancy or breast feeding,
-
Hypersensitivity to study drugs.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Xuanwu Hospital | Beijing | Beijing | China | 100053 |
| 2 | Zhongshan Hospital, Xiamen University | Xiamen | Fujian | China | |
| 3 | Nanfang Hospital, Southern Medical University | Guangzhou | Guangdong | China | |
| 4 | Xiangya Hospital, Central South University | Changsha | Hunan | China | |
| 5 | Xijing Hospital | Shanxi | Xi'an | China | |
| 6 | The First People's Hospital of Yunnan Province | Kunming | Yunnan | China |
Sponsors and Collaborators
- Xuanwu Hospital, Beijing
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- WEIBANYIZHENGHAN[2012]649