Comparison of phenobarbital and sodium valproate for the treatment of status epilepticus in children.

Abstract

Objectives: Seizure is considered to be one of the commonest emergency involving more than half of the admissions in Pediatric Neurology wards. It has been well documented that proper management not only improves the prognosis but also decrease complications in these children. This study was planned to compare phenobarbital against sodium valproate for the treatment of status epilepticus (SE) in children. Study Design: Randomized clinical trial. Setting: Emergency Department of Pediatrics Medicine, the Baqai University and Medical College, Karachi. Period: 15^th July 2018 to 31^st December 2018. Material & Methods: A total of 100 children (50 in each group) with seizure lasting longer than 5 minutes, aged 6 months to 12 years, did not respond to diazepam (0.2mg/kg)  within five minutes, were enroll. Randomization was done using lottery system where Group A was nominated who used sodium valproate and Group B, phenobarbital. Good response was labeled if a child’s seizure was controlled within 20 minutes of treatment. Results: Out of total of 100 children included in the present study, there were 60 (60.0%) male and 40 (40.0%) female. Mean age of the children was 5.4 years with standard deviation of 2.2 years. As far as type of seizures are concerned, there were 43 (43.0%) children presented with febrile convulsions (FC) while 57 (57.0%) with SE.  Overall, positive response was noted in 69 (69.0%) children. Response in between both the groups turned out to be of statistical significance as more children, 40 (80.0%) showed positive response in Group B in comparison to 29 (58.0%) in Group A (p value = 0.017). Amongst children with positive response, the difference between both the study groups was significant in relation to seizure types as 75.9% of children with SE showed positive response with sodium valproate while 52.5% children with FC showed positive response in Group B (p value=0.018). Conclusion: Overall, both study drugs showed good positive response but phenobarbital when compared to sodium valproate is a better choice for controlling seizure in pediatric population. Sodium valproate showed greater effectiveness when used in children with SE while phenobarbital was comparatively more effective in febrile convulsion.