Can treatment with anesthetic anticonvulsive drugs worsen outcome in status epilepticus?

Abstract

Nowadays, there is an ongoing discussion about the risks and benefits of anesthetic treatment concerning outcome in status epilepticus (SE). Therefore, we performed aretrospective database analysis to examine the influence of treatment with anesthetic drugs and narcosis in SE on mortality and disability. All treatment episodes of SE at the Department of Neurology of the University of Rostock between 01January 2000 and 31December 2009 were evaluated. SE severity before treatment, mortality, and disability at discharge were taken into account. Of 167 treatment episodes of SE,34 included treatment with anesthetic anticonvulsive drugs and narcosis. In the treatment episodes with use of anesthetic anticonvulsive drugs and narcosis, there was amore than twofold increased risk for death compared to the other treatment episodes. However, due to sample size this difference was not significant (p= 0.09). Cardiopulmonary complications were the cause of death in 4 of 5patients dying during treatment episodes with anesthetic anticonvulsive drugs and narcosis. At discharge, disability as measured with the Modified Rankin Scale was higher in patients treated with anesthetic anticonvulsive drugs and narcosis than in the others (p= 0.03). A subgroup analysis revealed that especially in patients with nonconvulsive SE with impaired consciousness treatment with narcosis was associated with ahigher rate of new deficits or mortality (p= 0.012). Especially when considering narcosis for treatment of nonconvulsive SE, risks and benefits should be carefully weighed. When treating SE with anesthetic drugs and narcosis, everything has to be done to avoid cardiopulmonary complications.