Abstracts

RATIONALE: Nonsurgical epilepsy patients admitted to an epilepsy monitoring unit (EMU) often require aggressive initiation or re-initiation of therapy prior to discharge. Slow or low antiepilepsy drug (AED)dosing at this time risks persistent frequent seizures soon after the patient is sent home. Too rapid or high AED dosing risks acute adverse effects which can delay discharge. We developed a simple dosing scheme using IV Depacon and Depakote ER to determine if the time required for initiation of therapy on the day of discharge could be minimized, without increasing the likelihood of post-discharge seizures and adverse effects.
METHODS: We identified 22 active epilepsy patients in the University of South Alabama EMU, naive to both Depacon and Depakote-ER, for whom one of the discharge AEDs would include Depakote. The population was compared by age, sex, seizure localization and baseline frequency, polytherapy and previous exposure to standard release(SR) Depakote. On the day of discharge, all patients were loaded with 20 mg/kg IV Depacon through a peripheral IV at 6 mg/kg/min, followed by 20 mg/kg Depakote-ER within one hour. Discharge dose of Depakote-ER was 20mg/kg/d. We assessed tolerability and seizure occurrence during the infusion, at one and four hours, and at one week after discharge.
RESULTS: All 22 patients tolerated receiving the full IV dose at 6 mg/kg/min followed by oral dose within one hour. 3 patients complained of nausea, and 2 complained of dizziness at four hours. No seizures or significant changes in heart rate or blood pressure occurred within four hours, and all patients were discharged within 24 hours. All patients denied systemic complaints at one week, but four had recurrent seizures. No patient had increased seizure frequency from baseline. There were no differences in tolerability based on sex, age, seizure localization or prior exposure to Depakote. Two of the 3 patients with nausea and both of those with dizziness were on another AED (oxcarbazepine, levetiracetam) at the time of Depacon infusion. Three additional patients who received SR Depakote after Depacon complained of dizziness and mild nausea which improved over 24 hours.
CONCLUSIONS: Depacon IV is well tolerated for rapid loading in the EMU. When promptly followed by Depakote-ER, tolerability and seizure control remain excellent through at least the first week after EMU discharge. The simplified dosing scheme of 20mg/kg for both formulations was not only successful in limiting adverse effects and breakthrough seizures, but was also easy for staff to implement. We conclude that this is a well-tolerated method for loading and initiating maintenance therapy of epilepsy patients for whom Depakote is the appropriate AED.
Disclosure: Grant - Abbott, Novartis; Honoraria - Abbott, Novartis, UCB-Pharma