Isoflurane Use in the Treatment of Super-Refractory Status Epilepticus is Associated with Hippocampal Changes on MRI

Ikeda, Kristin M.; Connors, Robert H.; Lee, Donald H.; Khandji, Alexander G.; Claassen, Jan; Young, G. Bryan

doi:10.1007/s12028-016-0340-0

Cited by 13 publications

(14 citation statements)

References 37 publications

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“…It has been suggested that isoflurane may cause morphological cerebral MRI changes, especially in the thalamus, hippocampus, and cerebellum, because of proposed disturbances in brain metabolism in a dose-dependent and/or time-dependent manner [28,29]. On the other hand, similar peri-ictal MRI changes can also be caused by prolonged seizure activity itself [30].…”

Section: Discussionmentioning

confidence: 99%

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Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

et al. 2021

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Background We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs). Methods This was a multicenter retrospective study of patients with RSE/SRSE treated with isoflurane for status epilepticus termination admitted to the neuro-ICUs of nine German university centers during 2011–2018. Results We identified 45 patients who received isoflurane for the treatment of RSE/SRSE. During isoflurane treatment, electroencephalograms showed no epileptiform discharges in 33 of 41 (80%) patients, and burst suppression pattern was achieved in 29 of 41 patients (71%). RSE/SRSE was finally terminated after treatment with isoflurane in 23 of 45 patients (51%) for the entire group and in 13 of 45 patients (29%) without additional therapy. Lengths of stay in the hospital and in the neuro-ICU were significantly extended in cases of ongoing status epilepticus under isoflurane treatment (p = 0.01 for length of stay in the hospital, p = 0.049 for length in the neuro-ICU). During isoflurane treatment, side effects were reported in 40 of 45 patients (89%) and mainly included hypotension (n = 40, 89%) and/or infection (n = 20, 44%). Whether side effects occurred did not affect the outcome at discharge. Of 22 patients with follow-up magnetic resonance imaging, 2 patients (9%) showed progressive magnetic resonance imaging alterations that were considered to be potentially associated with RSE/SRSE itself or with isoflurane therapy. Conclusions Isoflurane was associated with a good effect in stopping RSE/SRSE. Nevertheless, establishing remission remained difficult. Side effects were common but without effect on the outcome at discharge.

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Section: Discussionmentioning

confidence: 99%

“…The study was approved by the Cologne University Ethics Committee (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Because of the retrospective study design, written informed consent was waived.…”

Section: Patient Cohortmentioning

confidence: 99%

Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

et al. 2021

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“…Additionally, clinicians should consider inhaled anesthetics such as isoflurane and desflurane in prolonged cases of SRSE [ 32 ]. However, hippocampal atrophy was reported with the use of inhaled anesthetics [ 33 ]. In this section, we discuss the most commonly used anesthetics for the treatment of RSE and SRSE ( Table 2 ).…”

Section: Treatment Of Rse and Srsementioning

confidence: 99%

Review and Updates on the Treatment of Refractory and Super Refractory Status Epilepticus

Alolayan

McKinley

Bhatia

et al. 2021

JCM

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Refractory and super-refractory status epilepticus (RSE and SRSE) are life-threatening conditions requiring prompt initiation of appropriate treatment to avoid permanent neurological damage and reduce morbidity and mortality. RSE is defined as status epilepticus that persists despite administering at least two appropriately dosed parenteral medications, including a benzodiazepine. SRSE is status epilepticus that persists at least 24 h after adding at least one appropriately dosed continuous anesthetic (i.e., midazolam, propofol, pentobarbital, and ketamine). Other therapeutic interventions include immunotherapy, neuromodulation, ketogenic diet, or even surgical intervention in certain cases. Continuous electroencephalogram is an essential monitoring tool for diagnosis and treatment. In this review, we focus on the diagnosis and treatment of RSE and SRSE.

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“…• Inhalational anesthetics: Isoflurane and less commonly, desflurane, have been described for the treatment of SRSE. 55,56 There are several problems associated with the use of volatile anesthetics such as hypotension and frequent relapse of seizures upon termination of the anesthetic. There are also concerns of direct neurotoxicity with the use of high doses of isoflurane.…”

Section: Management Of Super-refractory Status Epilepticusmentioning

confidence: 99%

Management of Status Epilepticus

Lamsal

Bista

2019

Journal of Neuroanaesthesiology and Critical Care

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Status epilepticus (SE) is a life-threatening neurologic condition that requires immediate assessment and intervention. Over the past few decades, the duration of seizure required to define status epilepticus has shortened, reflecting the need to start therapy without the slightest delay. The focus of this review is on the management of convulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment of both forms of status epilepticus includes immediate assessment and stabilization, and administration of rapidly acting benzodiazepine therapy followed by nonbenzodiazepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and SRSE) pose a lot of therapeutic problems, necessitating the administration of continuous infusion of high doses of anesthetic agents, and carry a high risk of debilitating morbidity as well as mortality. AbstractKeywords ► convulsive status epilepticus ► neurocritical care ► nonconvulsive status epilepticus ► refractory status epilepticus ► status epilepticus ► super-refractory status epilepticus

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Isoflurane Use in the Treatment of Super-Refractory Status Epilepticus is Associated with Hippocampal Changes on MRI

Cited by 13 publications

References 37 publications

Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

Review and Updates on the Treatment of Refractory and Super Refractory Status Epilepticus

Management of Status Epilepticus

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