The results of treatment of refractory status epilepticus (SE) with IV valproate (VPA) in 41 children are reported from University Hospital for Children, Erlangen, Germany. Twenty two patients had previously received long-term antiepileptic therapy, whereas the SE was the initial presentation of a seizure disorder in 19. Initial treatment with diazepam, phenobarbital, and phenytoin had failed. The initial loading dose of IV VPA was 20 to 40 mg/kg/body weight, diluted 1:1 with normal saline or 5% dextrose, and given over 1 to 5 minutes, repeated after 10 to 15 minutes if necessary. When seizures had ceased for 12 hours and the EEG was normalized, VPA dosage was reduced.
The response rate was 78%, 66% being controlled within 2 to 6 minutes. The highest success rate was obtained with dosages between 30 and 40 mg/kg/bwt, and correlated with higher VPA blood levels in immediate responders (121 +/- 10 mg/L) compared to levels of 93 +/- 6 mg/L in delayed responders. There were no VPA-related systemic side effects. 
COMMENT. IV valproate is an effective and well tolerated alternative therapy for refractory status epilepticus in children.