Isoflurane Stops Refractory Seizures

Kofke, W. Andrew; Snider, Michael T.; O'Connell, Bridget; Young, Richard S.; Ropper, Allan H.; Gray, Lawrence; Johnson, Darren L.; Davis, Peter J.; Woelfel, S. K.; Gelb, Adrian W.

doi:10.1097/00000542-198709001-00400

Cited by 6 publications

(16 citation statements)

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“…In animals, isoflurane produced complete suppression of drug-induced convulsions (81)(82)(83)(84). In patients with status epilepticus resistant to conventional therapy, isoflurane-0, produced rapid cessation of seizures with a burst suppression pattern at inspired concentrations ranging from 0.5% to 3.0% (74,82,83,85) (Table 3). When isoflurane was discontinued after exposures lasting 1-54 h, seizures recurred in 50% of the patients studied.…”

Section: (29)mentioning

confidence: 99%

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Modica

Tempelhoff

White

1990

Anesthesia & Analgesia

146

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Many inhaled anesthetics and intravenous analgesics have been alleged to produce both proconvulsant and anticonvulsant activity in humans. The reasons for these contrasting actions on the CNS are poorly understood at the present time. However, biologic variability plays an important role in determining individual patient's responses to anesthetic and analgesic drugs. In addition, variations in the responsiveness of inhibitory and excitatory neurons to the central depressant effects of these drugs could also explain these apparently conflicting data. Depending on the brain concentration, centrally active drugs may produce differing effects on the CNS inhibitory and excitatory neurotransmitter systems. The availability of increasingly powerful magnetic resonance imaging techniques to provide noninvasive information about tissue chemistry (e.g., neurotransmitters and citric acid cycle metabolites) and positron emission tomography to noninvasively evaluate CNS drug-receptor interactions should lead to a more in-depth understanding of the in vivo effects of anesthetics and analgesics on the CNS. In the second part of this review article, we discuss the pro- and anticonvulsant effects of the sedative-hypnotics, local anesthetics, and other anesthetic adjuvant drugs.

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Section: (29)mentioning

confidence: 99%

Pro-and Anticonvulsant Effects of Anesthetics (Part I)

Modica

Tempelhoff

White

1990

Anesthesia & Analgesia

146

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“…Of the 19 articles included in the review, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] all were original studies. Kofke et al 18 included patient data from 2 of the other 19 articles. 17,25 Similarly, Kofke et al 19 contained data from 1 of the 19 articles.…”

Section: Resultsmentioning

confidence: 99%

“…Three articles were published meeting abstracts. 12,18,27 There were 18 retrospective studies 10,12-28 and 1 prospective study. 11 Thus the potential for significant publication bias is present.…”

Section: Resultsmentioning

confidence: 99%

“…11 Thus the potential for significant publication bias is present. Within the retrospective studies, eight were retrospective case series 10,12,[17][18][19]23,26,27 and the remaining ten were retrospective case reports. [13][14][15][16][20][21][22]24,25,28 The retrospective case series were composed of six single-center reviews 10,12,17,23,26,27 and two multicenter reviews.…”

Section: Resultsmentioning

confidence: 99%

“…[13][14][15][16][20][21][22]24,25,28 The retrospective case series were composed of six single-center reviews 10,12,17,23,26,27 and two multicenter reviews. 18,19 The one prospective study included in the systematic review was a prospective cohort study with no control group. 11 Fourteen articles described the use of inhaled anesthetic in adults, [13][14][15][16][18][19][20][22][23][24][25][26][27][28] with Ropper et al 25 containing duplicate patient data.…”

Section: Resultsmentioning

confidence: 99%

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Modern Inhalational Anesthetics for Refractory Status Epilepticus

Zeiler

Teitelbaum

et al. 2015

Can. J. Neurol. Sci.

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Background: Our goal was to perform a systematic review of the literature on the use of modern inhalational anesthetic agents for refractory status epilepticus and their impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to March 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology by two independent reviewers. Results: Overall, 19 studies were identified, with 16 manuscripts and 3 meeting abstracts. A total of 46 patients were treated. Adult (n = 28) and pediatric patients (n = 18) displayed 92.9% and 94.4% seizure control with treatment, respectively. Isoflurane was used in the majority of cases. Hypotension was the only complication described. Conclusions: Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence exists to support the use of isoflurane in refractory status epilepticus to obtain burst suppression. Insufficient data exist to comment on the efficacy of desflurane and xenon at this time.

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