Sodium Valproate And Divalproex

Sodium valproate and divalproex (a combination of sodium valproate and valproic acid in a molar ratio of 1:1) were reported to be effective in painful diabetic neuropathy in two small studies from a single center.83[II], 84[II] Valproate at a dose of 1200 or 1000mg/day was compared with placebo for one and three months, respectively. Significant improvement was claimed with a combined NNT for moderate or better pain relief of 1.5 (95 percent CI 1.2, 2.2).9[I] However, one must raise concerns regarding methodology, especially as the nature of randomization, blinding, and statistical analyses used in these studies were inadequately described. Moreover, in another small placebo-controlled cross-over study of 37 patients with polyneuropathy, mostly diabetic, valproate showed no benefit.85[II] Unusually, a placebo response was minimal or lacking in all these trials.83[II], 85[II] All were probably underpowered to detect a genuine difference. A further small controlled study conducted in 42 patients with PHN randomized to valproic acid (1000mg/day) or placebo was positive in favor of the former, with an NNT of 2.1 (95 percent CI 1.4, 4.2) but no corroborative studies have been published.86[II] While inconsistent results from these small studies prevent firm conclusions, some guidelines do recommend sodium valproate as second, third, or fourth line option for the management of neuropathic pain of peripheral origin.9[I], 15[I], 16[I]

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Peripheral Neuropathy Natural Treatment Options

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