Onset Refractory Status Epilepticus Research Articles

Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane.

Refractory status epilepticus (RSE) is defined as continued seizures after 2 or 3 antiepileptic drugs have failed. Several intravenous agents have been used for RSE; however, problems occur with their toxicity and/or effectiveness. To report our experience with inhalational anesthesia (IA) in patients who were refractory to other antiepileptic drugs. Retrospective review during a 4-year period of patients with RSE treated with isoflurane and/or desflurane. Efficacy of IA on therapy in terminating RSE. Seven patients (4 male) aged 17 to 71 years received 7 to 15 (mean, 10) antiepileptic drugs in addition to IAs. The IAs were initiated after 1 to 103 (mean, 19) days of RSE and were used for a mean +/- SD 11 +/- 8.9 days. All patients received isoflurane, and 1 patient in addition received desflurane anesthesia 21 days after the onset of RSE for a total of 19 days. Regardless of seizure type, isoflurane and desflurane consistently stopped epileptic discharges with adequate, sustained electroencephalographic burst suppression within minutes of initiating IA therapy. Four patients had good outcomes, 3 died (1 of acute hemorrhagic leukoencephalitis, 1 of bowel infarction, and 1 of toxic encephalopathy, who remained in a persistent vegetative state until death 5.5 months after the onset of seizures). Complications during IA therapy included hypotension (7/7), atelectasis (7/7), infections (5/7), paralytic ileus (3/7), and deep venous thrombosis (2/7). No patient developed renal or hepatic dysfunction. Isoflurane and desflurane adequately suppressed RSE in all cases. Complications were common, but mortality and long-term morbidity were related to the underlying disease and duration of RSE. Prolonged use of isoflurane and desflurane is well tolerated.

Outcome of Refractory Status Epilepticus

Neurology| April 01 2002 Outcome of Refractory Status Epilepticus AAP Grand Rounds (2002) 7 (4): 44. https://doi.org/10.1542/gr.7-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outcome of Refractory Status Epilepticus. AAP Grand Rounds April 2002; 7 (4): 44. https://doi.org/10.1542/gr.7-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: grand mal status epilepticus, refractory Source: Sahin M, Menache CC, Holmes GL, et al. Outcome of severe refractory status epilepticus in children. Epilepsia. 2001;42:1461–1467. The records of 22 children, ages 4.5 months to 18 years, treated for refractory status epilepticus (RSE) between 1992 and 2000, were reviewed retrospectively at Children’s Hospital, Boston, Massachusetts. Treatment consisted of high-dose anesthetic agents, including pentobarbital, midazolam, propofol, and phenobarbital, alone or in combination, for periods ranging from 2 to 146 days (mean 31 days). Outcome correlated with duration of treatment: of 8 children treated for <7 days, only 2 died and 4 returned to baseline neurologic state, whereas of 7 children requiring treatment of RSE for >31 days, 4 died and only 1 returned to baseline. A total mortality of 32% (7 cases) was related to etiology, age, and EEG. The most frequent etiology was presumed or known viral encephalitis affecting 10 children, of whom 4 died. Of 4 children <3 years of age, none returned to baseline, 3 died, and 1 had new neurologic deficits after RSE. Of 6 children older than 10 years, 4 returned to baseline, and only 1 died. Mortality was 25% in 12 children with focal EEG abnormalities at onset of RSE, and 40% in 10 with multifocal or generalized EEG abnormalities. No deaths occurred in 5 seizure-susceptible children with symptomatic seizures not due to an acute provocation; their diagnoses were mental retardation, Rett’s syndrome, old intracranial hemorrhage, atypical Rasmussen encephalitis, and developmental delay. The findings of the above study are similar to a study of 346 adolescent and adult patients with status epilepticus reported from the Netherlands.1 A poor outcome was related to the underlying cause and status associated with an acute illness, a duration of >4 hours, the occurrence of medical complications, and inadequate therapy. Of 38 patients who died, 44% received insufficient therapy. A study in 74 adults with 83 episodes of status epilepticus at the Neurological Institute, New York City,2 found a mortality of 21% which was correlated with increased age and acute symptomatic seizures. Increased length of hospitalization and acute symptomatic seizures were predictors of functional disability in 23% of patients with nonfatal episodes. Regarding long-term outcome, the occurrence of status with recovery had no adverse effects in a cohort of 342 children followed prospectively for a mean of 72 months.3 It appears that mortality with status is related particularly to the cause of the status and the association of an acute illness such as encephalitis or encephalopathy and, sometimes, to inadequate therapy. Although the majority of single, generalized tonic-clonic seizures are self-limiting and of no more than 2 to 4 minutes duration, a seizure lasting 5 minutes or more may progress to status and should be treated aggressively. The prevention of status and the effective treatment of status are dependent upon the avoidance of delay in initiating anticonvulsant therapy and the adherence to a well-defined protocol for managing prolonged seizures outlined for emergency room physicians.4 RSE may not... You do not currently have access to this content.