Background Information:

ACEP has recently revised its 2004 policy on critical issues in the evaluation and management of adult patients with seizures in the emergency department.

Pertinent Study Design and Conclusions:

• A literature review was conducted to derive evidence-based recommendations to help clinicians answer 4 critical questions. Only recomendations relating to question number 4 are presented in this pearl.
• Evidence suggests that in cases refractory to benzodiazepine, valproate works as well as phenytoin and fosphenytoin in status epilepticus as a second-line agent. Compared to phenytoin or fosphenytoin, valproate can be given more quickly and has fewer adverse effects (Level B recommendation).
• This recommendation is intended for adult patients aged 18 years and older presenting to the ED with generalized convulsive seizures.

Bottom Line:

As an alternative to phenytoin or fosphenytoin, valproate may be considered for refractory convulsive status epilepticus if benzodiazepines fail.

University of Maryland Section of Global Emergency Health

Author: Walid Hammad, MB ChB

References

1. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Seizures:, Huff JS, Melnick ER, Tomaszewski CA, ThiessenME, Jagoda AS, Fesmire FM. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department WithSeizures. Ann Emerg Med. 2014 Apr;63(4):437-447.
2. ACEP Clinical Policies Committee; Clinical Policies Subcommittee on Seizures. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med.2004 May;43(5):605-25.

Attachments

• 1404301058_ACEP_Clinical_Policy_Neurology_2014.pdf (607 Kb)
• 1404301059_ACEP_Clinical_Policy_Neurology_2004.pdf (217 Kb)