Prolonged High-Dose Isoflurane for Refractory Status Epilepticus

Fugate, Jennifer E.; Burns, Joseph D.; Wijdicks, Eelco F. M.; Warner, David O.; Jankowski, Christopher J.; Rabinstein, Alejandro A.

doi:10.1213/ane.0b013e3181f6da34

Cited by 51 publications

(44 citation statements)

References 23 publications

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“…We found 14 adult cases of SRSE with detailed clinical descriptions (Bausell et al, 2011;Finné Lenoir et al, 2013;Fugate et al, 2010;Hocker et al, 2014;Johnson et al, 2010;Kanter et al, 2008;Kondziella et al, 2008;Krishnamurthy and Drislane, 1997;Mirski et al, 1995;Moseley and Degiorgio, 2014;Prüss and Holtkamp, 2008;Robakis and Hirsch, 2006;Standley et al, 2012;Thordstein and Constantinescu, 2012) (see Table 3). Almost all of these patients were young (27 year-old; range, 17-68).…”

Section: Case Reports Of Prolonged Super Refractory Status Epilepticumentioning

confidence: 93%

Is Favorable Outcome Possible After Prolonged Refractory Status Epilepticus?

Alvarez

Drislane

2016

Journal of Clinical Neurophysiology

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When status epilepticus (SE) remains refractory to appropriate therapy, it is associated with high mortality and with substantial morbidity in survivors. Many outcome predictors such as age, seizure type, level of consciousness before treatment, and mostly, etiology, are well-established. A longer duration of SE is often associated with worse outcome, but duration may lose its prognostic value after several hours. Several terms and definitions have been used to describe prolonged, refractory SE, including "malignant SE," "prolonged" SE, and more recently, "super refractory" SE, defined as "SE that has continued or recurred despite 24 hours of general anesthesia (or coma-inducing anticonvulsants)." There are few data available regarding the outcome of prolonged refractory SE, and even fewer for SE remaining refractory to anesthetic drugs. This article reviews reports of outcome after prolonged, refractory, and "super refractory" SE. Most information detailing the clinical outcome of patients surviving these severe illnesses, in which seizures can persist for days or weeks (and especially those concerning "super-refractory" SE) come from case reports and retrospective cohort studies. In many series, prolonged, refractory SE has a mortality of 30% to 50%, and several studies indicate that most survivors have a substantial decline in functional status. Nevertheless, several reports demonstrate that good functional outcome is possible even after several days of SE and coma induction. Treatment of refractory SE should not be withdrawn from younger patients without structural brain damage at presentation solely because of the duration of SE.

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Section: Case Reports Of Prolonged Super Refractory Status Epilepticumentioning

confidence: 93%

Is Favorable Outcome Possible After Prolonged Refractory Status Epilepticus?

Alvarez

Drislane

2016

Journal of Clinical Neurophysiology

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“…Several patients required vasopressors, paralytic ileus occurred in some, and the high fatality rates (43%–67%) reflect the difficult long-term control and the impact of the underlying disease 71, 72 . Furthermore, one recent report of isoflurane in RSE raised questions about CNS toxicity, especially in thalamic and cerebellar regions 73 . The intravenous anesthetic agent ketamine has also been tried in RSE, given its properties as an NMDA receptor antagonist and favorable hemodynamic profiles.…”

Section: Other Pharmacological Approaches (Summarized In Table 2)mentioning

confidence: 99%

Management of refractory status epilepticus in adults: still more questions than answers

Rossetti

Lowenstein

2011

The Lancet Neurology

279

227

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Summary Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. RSE should be treated promptly to prevent morbidity and mortality; however, scarce evidence is available to support the choice of specific treatments. Major independent outcome predictors are age (not modifiable) and etiology (that should be actively targeted). Recent recommendations for adults, relying upon limited evidence, suggest that RSE treatment aggressiveness should be tailored to the clinical situation: to minimize ICU-related complications, focal RSE without major consciousness impairment might initially be approached more conservatively; conversely, early induction of pharmacological coma is advisable in generalized-convulsive forms. At this stage, midazolam, propofol or barbiturates represent the most used alternatives. Several other treatments, such as additional anesthetics, other antiepileptic or immunomodulatory compounds, or non-pharmacological approaches (electroconvulsive treatment, hypothermia), have been used in protracted RSE. Treatment lasting weeks or months may sometimes result in a good outcome, as in selected cases after cerebral anoxia and encephalitis. Well-designed prospective studies of this condition are urgently needed.

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“…In recent years, a large number of animal studies investigated the potential neuroprotective effect of volatile sedative agents [6][7][8][9][10][11][12][13][14][15]. In vivo, it has been demonstrated that preconditioning with isoflurane improves long-term neurologic outcome after hypoxic-ischemic bran injury in neonatal rats, in adult mice, and after focal brain ischemia in adult rats.…”

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confidence: 99%