Treatment of Refractory Status Epilepticus with Propofol: Clinical and Pharmacokinetic Findings

Stecker, Mark M.; Kramer, Thomas H.; Raps, Eric C.; O'Meeghan, Rosemary; Dulaney, Eugene L.; Skaar, Debra J.

doi:10.1111/j.1528-1157.1998.tb01269.x

Cited by 215 publications

(134 citation statements)

References 39 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…Refractory status epilepticus (RSE), defined as SE that fails to respond to first-and second-line therapy, occurs in 9-31% of patients with SE (1-3) and is associated with high morbidity and high mortality (4)(5)(6)(7). Treatment of RSE has not been studied in a prospective trial, and guidelines give a spectrum of options.…”

mentioning

confidence: 99%

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

et al. 2002

View full text Add to dashboard Cite

Summary:Background: New continuous infusion antiepileptic drugs (cIV-AEDs) offer alternatives to pentobarbital for the treatment of refractory status epilepticus (RSE). However, no prospective randomized studies have evaluated the treatment of RSE. This systematic review compares the efficacy of midazolam (MDL), propofol (PRO), and pentobarbital (PTB) for terminating seizures and improving outcome in RSE patients.Methods: We performed a literature search of studies describing the use of MDL, PRO, or PTB for the treatment of RSE published between January 1970 and September 2001, by using MEDLINE, OVID, and manually searched bibliographies. We included peer-reviewed studies of adult patients with SE refractory to at least two standard AEDs. Main outcome measures were the frequency of immediate treatment failure (clinical or electrographic seizures occurring 1 to 6 h after starting cIV-AED therapy) and mortality according to choice of agent and titration goal (cIV-AED titration to "seizure suppression" versus "EEG background suppression").Results: Twenty-eight studies describing a total of 193 patients fulfilled our selection criteria: MDL (n ‫ס‬ 54), PRO (n ‫ס‬ 33), and PTB (n ‫ס‬ 106). Forty-eight percent of patients died, and mortality was not significantly associated with the choice of agent or titration goal. PTB was usually titrated to EEG background suppression by using intermittent EEG monitoring, whereas MDL and PRO were more often titrated to seizure suppression with continuous EEG monitoring. Compared with treatment with MDL or PRO, PTB treatment was associated with a lower frequency of short-term treatment failure (8 vs. 23%; p < 0.01), breakthrough seizures (12 vs. 42%; p < 0.001), and changes to a different cIV-AED (3 vs. 21%; p < 0.001), and a higher frequency of hypotension (systolic blood pressure <100 mm Hg; 77 vs. 34%; p < 0.001). Compared with seizure suppression (n ‫ס‬ 59), titration of treatment to EEG background suppression (n ‫ס‬ 87) was associated with a lower frequency of breakthrough seizures (4 vs. 53%; p < 0.001) and a higher frequency of hypotension (76 vs. 29%; p < 0.001).Conclusions: Despite the inherent limitations of a systematic review, our results suggest that treatment with PTB, or any cIV-AED infusion to attain EEG background suppression, may be more effective than other strategies for treating RSE. However, these interventions also were associated with an increased frequency of hypotension, and no effect on mortality was seen. A prospective randomized trial comparing different agents and titration goals for RSE with obligatory continuous EEG monitoring is needed.

show abstract

mentioning

confidence: 99%

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

et al. 2002

View full text Add to dashboard Cite

show abstract

“…48,49 Propofol has fallen into relative disfavor because of increasing anecdotal reports of deaths associated with prolonged or excessive use. [51][52][53][54][55] Use of propofol in children is a black box contraindication. This has been attributed to the development of a metabolic acidosis associated with hypotension, rhabdomyolysis, and hyperlipidemia.…”

Section: Refractory Status Epilepticusmentioning

confidence: 99%

Status Epilepticus

Manno

2011

The Neurohospitalist

View full text Add to dashboard Cite

Status epilepticus is a neurological emergency that is commonly encountered by the neurohospitalist. Successful treatment depends upon the recognition of prolonged seizure activity and the acute mobilization of available resources. Pharmacologic treatment regimens have been shown to decrease the time needed for successful control of seizures and have provided for the rapid administration of anticonvulsant medications. Treatment strategies have evolved so that clinicians can administer effective doses of medication by whatever routes of administration are immediately available. Traditional algorithms for the treatment of status epilepticus have used a stepwise approach to the administration of first-, second-, and third-order medications. More recent options have included aggressive anesthetic doses of medications while second-line medications are being titrated.

show abstract

“…Some evidence suggests that propofol may not be as safe as midazolam in very ill patients [70,71]. One study found that propofol was associated with a 56% mortality rate in patients with Acute Physiology and Chronic Health Evaluation (APACHE) scores exceeding 20, whereas patients treated with midazolam had a 17% mortality rate [70].…”

Section: Propofolmentioning

confidence: 99%

Treatment of Acute Seizures and Status Epilepticus

Costello

Cole

2007

J Intensive Care Med

View full text Add to dashboard Cite

Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical. This review outlines key concepts related to status epilepticus, delineates an approach to the early management of status epilepticus, and highlights novel but practical approaches in the evaluation and treatment of refractory status epilepticus, emphasizing the use of a treatment algorithm. This review is written from the perspective of the intensive care unit clinician, and the approach and opinions expressed stem from clinical experience and review of the current literature. Particular attention is given to an overall approach to the management of convulsive status epilepticus in adults and older children as well as exploring novel approaches and diagnostic tools that may prove useful in difficult-to-control status epilepticus.

show abstract

Treatment of Refractory Status Epilepticus with Propofol: Clinical and Pharmacokinetic Findings

Cited by 215 publications

References 39 publications

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

Treatment of Refractory Status Epilepticus with Pentobarbital, Propofol, or Midazolam: A Systematic Review

Status Epilepticus

Treatment of Acute Seizures and Status Epilepticus

Contact Info

Product

Resources

About