Vigabatrin: A Novel Approach for Treatment of Super Refractory Status Epilepticus, a Case Study of 2 Patients (P01.079)

Abstract

Objective: Our objective is to present 2 cases of a potential new treatment for Super Refractory Status Epilepticus. Background Super Refractory Status Epilepticus (SRSE) is defined by continuous seizure activity for 24 hours or more even with treatment including general anesthesia. Approximately 15% of all cases of status epilepticus progress to a super refractory state (Shorvon et al. in the journal Brain). Although there are many algorithms for treatment, most of which include AEDs and anesthesia, there is little to no literature suggesting what to do next after treatment with the major antiepileptic drugs and anesthetic agents fail. Design/Methods: We present two cases where Vigabatrin (GVG), an irreversible binder of GABA transaminase, was successfully used for SRSE after exhausting the use of all the recommended treatment modalities. Results: Case 1 was an 82 yo RHWF with an intracerebral hemorrhage and case 2 was a 24 yo RHBM with presumed viral encephalitis. Both patients were started on regimens including Lorazepam, Levetiracetam, Lacosamide, and Valproic acid along with anesthesia including Propofol and Ketamine. In our second case, even more AEDs were tried, including Phenytoin, Carbamazepine, and Phenobarbital to no effect. In patient 2, cortical resection was done twice in attempt to control the SRSE. Vigabatrin via NG tube lead to cessation of SRSE within 24 hours of the first dose. Continuous EEG monitoring was used to determine outcome. Conclusions: SRSE is an entity that occurs in 15% of cases of status epilepticus, which has a high mortality rate. Treatment is not adequate nor is it standardized. We feel that these case reports reveal Vigabatrin as a potential treatment modality which has infrequently been reported in the literature. This could be a significant new option when conventional measures fail to control SRSE. Disclosure: Dr. McCormick has nothing to disclose. Dr. Jonas has nothing to disclose. Dr. Ramsay has received personal compensation for activities with Glaxo-Smith Kline, Lundbeck, Eisai, UCB Pharma DSMB, GSK, and UCB as a speaker and consultant. Dr. Sabharwal has nothing to disclose.