Cessation of epileptic seizures series using peroral valproate in an adult patient with partial epilepsy

Abstract

INTRODUCTION: Golden rule for the initiation of antiepileptic therapy in the majority of epileptic syndromes is "start low and go slow", a principle after the second unprovoked seizure. There are certain clinical situations however when fast titration of antiepileptic medication is needed. CASE REPORT: We present a case of the 48-year-old man referred for further management of uncontrolled partial seizures. At the age of 37 years, he had subarachnoid haemorrhage, due to aneurysm rupture of the left internal carotid artery, with consecutive vasospasm and right haemiparesis. Since that time he had received phenobarbital 100 mg nocte. On examination he had a right sided upper motor neuron weakness affecting the arm more than the leg, and mild dysarthria, EEG investigation showed frequent transitory spikewaves discharges above the left hemisphere with the fast contralateral propagation with generalised discharges and CT showed old infarction in distribution of left medial cerebral artery. Valproate therapy was initiated with the retard form in the loading dose of 2000 mg. Seizures stopped in 7th hours after the treatment initiation. Laboratory parameters (liver function tests, blood count, level of antiepileptic drugs) were monitored every day. No further seizures were recorded. The patient was discharged from the hospital after 15 days in excellent condition. CONCLUSION: In selected clinical conditions it is possible to apply the protocol for valproate loading and switch-off from the previous antiepileptic drugs to valproate monotherapy. Adverse effects are rare and mild but potentially serious, and close monitoring of clinical and laboratory parameters is necessary. Hence, a rapid switch to valproate monotherapy can be done safely only in an inpatient setting.