Sodium Valproate in the Prevention of Febrile Convulsions

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概要

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• The necessity and effectiveness of anticonvulsant therapy for the prevention of febrile convulsions are the controversial matters.<BR>The present study aimed to assess the effect of daily sodium valprote (VPA) for the prevention of febrile convulsions in relation to its plasma levels.One hundred children aged 7 months to 6 years were studied, who had febrile convulsions more than twice.VPA, 20-25mg/kg daily, was given to [I] 61 children (group A: 32 cases with"simple"febrile convulsions, and group B: 29 cases with"epilepsy triggered by fever") in two divided doses, and to [II] 39 children (group A: 22 cases, and group B: 17 cases) in three divided doses.They were followed closely for 6-22 months.<BR>The plasma concentrations of VPA were determined by gasliquid chromatography every 6 months.All blood samples were drawn 2-4 hours after the morning dose.During the follow-up period, all of these 100 children had febrile episodes.<BR>Recurrence rate was 21.3% (13/61) in group C I C, but only 1 (3.4%) of the 29 children whose plasma concentrations were above 80 ug/ml, had a new convulsion.On the other hand, recurrence rate was 12.8% (5/39) in group [II], and 4 of the 5 children who had a recurrence, showed the lower plasma concentrations below 50, ug/ml.<BR>This study suggests that the continuous therapy with VPA is effective for the prevention of febrile convulsion recurrences when plasma levels are maintained above 80, ug/ml in the group with two daily divided doses and above 50μg/ml in the group with three daily divided doses.<BR>In an additional trial, the daily fluctuations in steady state plasma concentration of VPA were examined in other 10 children;5 receiving two daily divided doses and 5 receiving three daily divided doses.<BR>The peak levels were higher in the former group due to the large single dosage (mg/kg) than in the latter, while the minimum levels stayed in almost the same range in both groups.<BR>Owing to the rapid absorption and the short biological half-life of VPA, and therefore to the considerable daily fluctuation of its plasma levels, it is necessary to standardize the time when doses are given and when blood samples are drawn, in evaluating the therapeutic plasma level of VPA.

• 一般社団法人 日本小児神経学会の論文

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