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Treatment of Refractory Status Epilepticus

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Refractory status epilepticus (RSE) is typically defined as seizure activity lasting more than 1 h that has not been terminated by first- or second-line treatment (1). Based on the results of a randomized controlled trial, lorazepam is commonly accepted as a first-line treatment agent for status epilepticus (2). Phenytoin (or fosphenytoin) is frequently used next, but the likelihood of successful treatment with traditional anticonvulsants is low after failure of the first agent (3). Selection of the third and fourth agents is a matter of controversy, and not the subject of any randomized trials.

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References

  1. Claassen J, Hirsch LJ, Emerson RG, Bates JE, Thompson TB, Mayer SA. Continuous EEG monitoring and midazolam infusion for refractory nonconvulsive status epilepticus. Neurology 2001;57:1036–1042.

    PubMed  CAS  Google Scholar 

  2. Treiman DM, Meyers PD, Walton NY, Collins JF Colling C, Rowan AJ, Handforth A, Faught E, Calabrese VP, Uthman BM, Ramsay RE, Mamdani MB. A comparison of four treatments for generalized convulsive status epilepticus: Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med 1998;17:792–798.

    Article  Google Scholar 

  3. Treiman DM, Walton NY, Collins JF. Treatment of status epilepticus if first drug fails. Epilepsia 1999;40:243(abstract).

    Google Scholar 

  4. Jagoda A, Riggio S. Refractory status epilepticus in adults. Ann Emerg Med 1993;22:1337–1348.

    Article  PubMed  CAS  Google Scholar 

  5. DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, Garnett L, Fortner CA, Ko D. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996;46:1029–1035.

    PubMed  CAS  Google Scholar 

  6. Krishnamurthy KB, Drislane FW. Relapse and survival after barbiturate anesthetic treatment of refractory status epilepticus. Epilepsia 1996;37:863–867.

    Article  PubMed  CAS  Google Scholar 

  7. Waterhouse EJ, Garnett LK, Towne AR, Morton LD, Barnes T, Ko D, DeLorenzo RJ. Prospective population-based study of intermittent and continuous convulsive status epilepticus in Richmond, Virginia. Epilepsia 1999;40:752–758.

    Article  PubMed  CAS  Google Scholar 

  8. Mazarati AM, Baldwin RA, Sankar R, Wasterlain CG. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res 1998;814;179–185.

    Article  PubMed  CAS  Google Scholar 

  9. Walton NY, Treiman DM. Response of status epilepticus induced by lithium and pilocarpine to treatment with diazepam. Exp Neurol 1988;101:267–275.

    Article  PubMed  CAS  Google Scholar 

  10. Sisodiya SM, Thom M. Widespread upregulation of drug-resistance proteins in fatal human status epilepticus. Epilepsia 2003;44:261–264.

    Article  PubMed  Google Scholar 

  11. Morrisett RA, Jope RS, Snead OC III. Effects of drugs on the initiation and maintenance of status epilepticus induced by administration of pilocarpine to lithium-pretreated rats. Exp Neurol 1987;97:193–200.

    Article  PubMed  CAS  Google Scholar 

  12. Alldredge BK, Lowenstein DH. Status epilepticus: new concepts. Curr Opin Neurol 1999;12:183–190.

    Article  PubMed  CAS  Google Scholar 

  13. Borris DJ, Bertram EH, Kapur J. Ketamine controls prolonged status epilepticus. Epilepsy Res 2000;42:117–122.

    Article  PubMed  CAS  Google Scholar 

  14. Rice AC, Delorenzo RJ. N-Methyl-D-aspartate receptor activation regulates refractoriness of status epilepticus to diazepam. Neuroscience 1999;93:117–123.

    Article  PubMed  CAS  Google Scholar 

  15. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol 2002;59:205–210.

    Article  PubMed  Google Scholar 

  16. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia 2002;43:146–153.

    Article  PubMed  CAS  Google Scholar 

  17. Logroscino G, Hesdorffer DC, Cascino G, Annegers JF, Hauser WA. Time trends in incidence, mortality, and case-fatality after first episode of status epilepticus. Epilepsia 2001;42:1031–1035.

    Article  PubMed  CAS  Google Scholar 

  18. Towne AR, Pellock JM, Ko K, DeLorenzo RJ. Determinants of mortality in status epilepticus. Epilepsia 1994;35:27–34.

    Article  PubMed  CAS  Google Scholar 

  19. Mirski MA, Williams MA, Hanley DF. Prolonged pentobarbital and phenobarbital coma for refractory generalized status epilepticus. Crit Care Med 1995;23:400–404.

    Article  PubMed  CAS  Google Scholar 

  20. DeGiorgio CM, Tomiyasu U, Gott PS, Treiman DM. Hippocampal pyramidal cell loss in human status epilepticus. Epilepsia 1992;33:23–27.

    Article  PubMed  CAS  Google Scholar 

  21. Dodrill CB, Wilensky AJ. Intellectual impairment as an outcome of status epilepticus. Neurology 1990;40(suppl 2):23–27.

    PubMed  CAS  Google Scholar 

  22. Young GB, Blume WT, Bolton CF, Warren KG. Anesthetic barbiturates in refractory status epilepticus. Can J Neurol Sci 1980;7:291–292.

    PubMed  CAS  Google Scholar 

  23. Osorio I, Reed RC. Treatment of refractory generalized tonic-clonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin. Epilepsia 1989;30:464–471.

    PubMed  CAS  Google Scholar 

  24. Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia 1999;40:759–762.

    Article  PubMed  CAS  Google Scholar 

  25. Rashkin MC, Youngs C, Penovich P. Pentobarbital treatment of refractory status epilepticus. Neurology 1987;37:500–503.

    PubMed  CAS  Google Scholar 

  26. Lowenstein DH, Aminoff MJ, Simon RP. Barbiturate anesthesia in the treatment of status epilepticus: Clinical experience with 14 patients. Neurology 1988;38:395–400.

    PubMed  CAS  Google Scholar 

  27. Yaffe K, Lowestein DH. Prognostic factors of pentobarbital therapy for refractory generalized status epilepticus. Neurology 1993;43:895–900.

    PubMed  CAS  Google Scholar 

  28. Parviainen I, Uusaro A, Kalviainen R, Kaukanen E, Mervaala E, Ruokonen E. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology 2002;22:1249–1251.

    Google Scholar 

  29. Roesch C, Haselby KA, Paradise RR, Krishna G, Dierdorf S, Wolfe TM, Rao CC. Comparison of cardiovascular effects of thiopental and pentobarbital at equivalent levels of CNS depression. Anesth Analg 1983;62:749–753.

    Article  PubMed  CAS  Google Scholar 

  30. Templeton KE. Phenobarbital for status. Neurology 1989;39:609 (letter).

    Google Scholar 

  31. Kumar A, Bleck TP. Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med 1992;20:483–488.

    Article  PubMed  CAS  Google Scholar 

  32. Naritoku DK, Sinha S. Prolongation of midazolam half-life after sustained infusion for status epilepticus. Neurology 2000;54:1366–1368.

    PubMed  CAS  Google Scholar 

  33. Prasad A, Worrall BB, Bertram EH, Bleck TP. Propofol and midazolam in the treatment of refractory status epilepticus. Epilepsia 2001;42:380–386.

    Article  PubMed  CAS  Google Scholar 

  34. Stecker MM, Kramer TH, Raps EC, O’Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: cinical and pharmacokinetic findings. Epilepsia 1998;39:18–26.

    Article  PubMed  CAS  Google Scholar 

  35. Hanna JP, Ramundo ML. Rhabdomyolysis and hypoxia associated with prolonged propofol infusion in children. Neurology 1998;50:301–303.

    PubMed  CAS  Google Scholar 

  36. Kofke WA, Young RS, Davis P, Woelfel SK, Gray L, Johnson D, Gelb A, Meeke R, Warner DS, Pearson KS, Gibson JR, Koncelik J, Wessel HB. Isoflurane for refractory status epilepticus: A clinical series. Anesthesiology 1989;71:653–659.

    Article  PubMed  CAS  Google Scholar 

  37. Meeke RI, Soifer BE, Gelb AW. Isoflurane for the management of status epilepticus. DICP 1989;23:579–581.

    PubMed  CAS  Google Scholar 

  38. Walker MC, Perry H, Scaravilli F, Patsalos PN, Shorvon SD, Jefferys JG. Halothane as a neuroprotectant during constant stimulation of the perforant path. Epilepsia 1999;40:359–364.

    Article  PubMed  CAS  Google Scholar 

  39. Sharpe MD, Young GB, Mirsattari S, Harris C. Prolonged desflurane administration for refractory status epilepticus. Anesthesiology 2002;97:261–264.

    Article  PubMed  Google Scholar 

  40. Yeoman P, Hutchinson A, Byrne A, Smith J, Durham S. Etomidate infusions for the control of refractory status epilepticus. Intensive Care Med 1989;15:255–259.

    Article  PubMed  CAS  Google Scholar 

  41. Evers AS, Crowder CM. General anesthetics. In: Hardman JG, Limbird LE, Gilman AG., eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw Hill; 2001:337–365.

    Google Scholar 

  42. Sheth RD, Gidal BE. Refractory status epilepticus: Response to ketamine. Neurology 1998;51:1765–1766.

    PubMed  CAS  Google Scholar 

  43. Bleck TP, Quigg MS, Nathan BR, Smith TL, Kapur J. Electrographic effects of ketamine treatment for refractory status epilepticus. Epilepsia 2002;43:282 (abstract).

    Google Scholar 

  44. DeGiorgio CM, Altman K, Hamilton-Byrd E, Rabinowicz AL. Lidocaine in refractory status epilepticus: confirmation of efficacy with continuous EEG monitoring. Epilepsia 1992;33:913–916.

    Article  CAS  Google Scholar 

  45. Aggarwal P, Wali JP. Lidocaine in refractory status epilepticus: A forgotten drug in the emergency department. Am J Emerg Med 1993;11:243–244.

    Article  PubMed  CAS  Google Scholar 

  46. Pascual J, Sedano MJ, Polo JM, Berciano J. Intravenous lidocaine for status epilepticus. Epilepsia 1988;29:584–589.

    PubMed  CAS  Google Scholar 

  47. Simon RP, Benowitz NL, Bronstein J, Jacob P. Increased brain uptake of lidocaine during bicuculline-induced status epilepticus in rats. Neurology 1982;32:196–199.

    PubMed  CAS  Google Scholar 

  48. Derlet RW, Albertson TE, Tharratt RS. Lidocaine potentiation of cocaine toxicity. Ann Emerg Med 1991;20:135–138.

    Article  PubMed  CAS  Google Scholar 

  49. Uberall MA, Trollmann R, Wunsiedler U, Wenzel D. Intravenous valproate in pediatric epilepsy patients with refractory status epilepticus. Neurology 2000;54:2188–2189.

    PubMed  CAS  Google Scholar 

  50. Venkataraman V, Wheless JW. Safety of rapid intravenous infusion of valproate loading doses in epilepsy patients. Epilepsy Res 1999;35:147–153.

    Article  PubMed  CAS  Google Scholar 

  51. Lowe MR, DeToledo JC, Vilavizza N, Ramsay RE. Efficacy, safety, and tolerability of fast i.v. loading of valproate in patients with seizures and status epilepticus. Epilepsia 1998;39:235(abstract).

    Article  Google Scholar 

  52. Yu KT, Mills S, Thompson N, Cunanen C. Safety and efficacy of intravenous valproate in pediatric status epilepticus and acute repetitive seizures. Epilepsia 2003;44:724–726.

    Article  PubMed  CAS  Google Scholar 

  53. Niebauer M, Gruenthal M. Topiramate reduces neuronal injury after experimental status epilepticus. Brain Res 1999;837:263–269.

    Article  PubMed  CAS  Google Scholar 

  54. Towne AR, Garnett LK, Waterhouse EJ, Morton LD, DeLorenzo RJ. The use of topiramate in refractory status epilepticus. Neurology 2003;60:332–334.

    PubMed  CAS  Google Scholar 

  55. Zimmerman RS, Sirven JI, Drazkowski JF, Bortz JL, Shulman DL. High-output current/rapid cycling vagus never stimulation for refractory status epilepticus: preliminary results. Epilepsia 2002;43:286 (abstract).

    Google Scholar 

  56. Gorman DG, Shields WD, Shewmon DA, Chugani HT, Finkel R, Comair YG, Peacock WJ. Surgical treatment of refractory status epilepticus. Epilepsia 1992;33:546–549.

    Article  PubMed  CAS  Google Scholar 

  57. Hill MW, Wong M, Amarakone A, Rothman SM. Rapid cooling aborts seizure-like activity in rodent hippocampal-entorhinal slices. Epilepsia 2000;41:1241–1248.

    PubMed  CAS  Google Scholar 

  58. Orlowski JP, Erenberg G, Lueders H, Crues RP. Hypothermia and barbiturate coma for refractory status epilepticus. Crit Care Med 1984;12:367–372.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Departments of Neurosurgery and Neurology, University of Michigan, Ann Arbor, MI

    Teresa L. Smith MD

  2. Departments of Neurology, Neurological Surgery, and Internal Medicine, Neuroscience Intensive Care Unit, University of Virginia School of Medicine, Charlottesville, VA

    Thomas P. Bleck MD, FCCM

Authors
  1. Teresa L. Smith MD
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  2. Thomas P. Bleck MD, FCCM
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Editors and Affiliations

  1. Harvard Medical School, Comprehensive Epilepsy Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts

    Frank W. Drislane MD (Associate Professor of Neurology) (Associate Professor of Neurology)

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© 2005 Humana Press Inc., Totowa, NJ

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Smith, T.L., Bleck, T.P. (2005). Treatment of Refractory Status Epilepticus. In: Drislane, F.W. (eds) Status Epilepticus. Current Clinical Neurology. Humana Press. https://doi.org/10.1385/1-59259-945-1:289

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  • DOI: https://doi.org/10.1385/1-59259-945-1:289

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-355-8

  • Online ISBN: 978-1-59259-945-5

  • eBook Packages: MedicineMedicine (R0)

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