Treatment of Generalized Epilepsies of Childhood and Adolescence with Sodium Valproate (‘Epilim’)

Abstract

A total of 142 patients (84% aged less than 20 yr) with various forms of generalized epilepsy were treated with sodium valproate alone or in combination with other drugs. The mean duration of symptoms was 6 yr, and half the patients had daily seizures. Nine patients had typical absences, 33 had absences with automatisms, 28 had tonic-clonic seizures with or without photosensitivity and 72 had various forms of myoclonic epilepsy. Dosage varied from 23-54 mg/kg and twice-daily administration was usual. Estimation of serum levels did not assist in management. Fits ceased in 63% of all cases and a further 18% showed improvement greater than 50%. Of the 69 with 3 c[cycles]/s spike-and-wave discharges, 81% became free from all fits, as did 77% of those with myoclonic jerks. Fits ceased in 8 of the 32 patients with myoclonic astatic epilepsy and there was improvement greater than 50% in an additional 8 patients. Other anticonvulsants were often withdrawn and always reduced. Patients (21) received sodium valproate alone from the start of treatment and all other drugs were withdrawn in another 38. Sodium valproate alone controlled all fits in 4 children with absences, in 18 with absences with automatisms, 10 with tonic-clonic seizures and 22 with myoclonic epilepsy. Side-effects were rare, mild and often temporary. Potentiation of barbiturates and benzodiazepines occurred, especially clonazepam, which should be avoided. Many patients were more alert. Sodium valproate appears to be the drug of choice for epilepsies associated with generalized spike-and-wave discharges, myoclonic epilepsies or photosensitive epilepsies, and is of special value in children and mentally retarded patients because it lacks sedating effects and often induces liveliness.