Anesthetic drugs for the treatment of status epilepticus

Abstract

Worsening pharmacoresistance to antiseizure drugs is common with ongoing excitotoxic neuronal and systemic injury. Early initiation of anesthetic drugs in refractory status epilepticus (RSE) may halt these processes while allowing time for treatment targeting the cause of the seizures. Current guidelines support the use of anesthetic drugs as the third line pharmacologic therapy in generalized convulsive status epilepticus but do not clearly define the indications for these drugs in other types of status epilepticus. There is wide practice variation in choice of third line therapy for RSE, but there is overall consensus that anesthetics should be initiated earlier in generalized convulsive status epilepticus than in nonconvulsive forms. More recently, doubt has been cast on the appropriateness of anesthetic treatment of RSE following a series of studies associating their use with higher mortality and morbidity. This suggests that efforts should focus on determination of who benefits most, optimal use, and prevention of refractoriness. The risk-benefit ratio of anesthetic use is discussed, with specific indications proposed. In addition, anesthetic dosing, supportive neurocritical care, electroencephalogram suppression target, and weaning of anesthesia are reviewed.

Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus

“…10 However, data supporting the adequacy of this threshold are lacking. In the context of the ongoing debate whether high-dose and prolonged IVADs in patients with RSE cause harm that may outweigh presumed benefits, [11][12][13][14][15][16] there is an utter need for further studies. Hence, we aimed to investigate the frequency of induced burst suppression during anesthesia and whether burst suppression was associated with specific outcomes in patients treated with IVADs for RSE.…”

Verbal and memory deficits caused by aphasic status epilepticus after resection of a left temporal lobe glioma

“…In this study, intravenous anesthetics halted ASE that was refractory to multiple ASDs. [ 10 ] They are one of the treatment options for focal NCSE; however, the optimal timeline for intervention has not yet been established. [ 10 ] The time point at which a delay in treatment results in disability is a key factor in deciding the timing of intervention for status epilepticus.…”

“…[ 10 ] They are one of the treatment options for focal NCSE; however, the optimal timeline for intervention has not yet been established. [ 10 ] The time point at which a delay in treatment results in disability is a key factor in deciding the timing of intervention for status epilepticus. Convulsive status epilepticus lasting more than 30 min can induce neuronal damage.…”

Anticonvulsive Drug Use in Status Therapy: Adults

“…However, despite its long story and being one of the better studied second-line treatment, it is now relatively rarely used as first choice molecule, due to its side effects (severe hypotension, sedation, cardiorespiratory depression) and unfavorable pharmacokinetics properties (very long half-life, potent drug inductor). This class is usually reserved as a thirdline treatment in coma induction (see the corresponding section) and may be occasionally used as a rescue medication at high dose for the relay after a longlasting coma induction (Hocker 2018).…”