Experience in rescue and treatment of patients with super-refractory status epilepticus and coma / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the efficacy and prognosis of using midazolam combined with atracurium for treatment of a patient with super-refractory status epilepticus (SRSE) and coma. Methods A case of SRSE and coma admitted to the Department of Critical Care Medicine of Renmin Hospital of Wuhan University in May 2018 was enrolled. The symptoms, signs, laboratory examinations and treatment process were summarized, and combined with the literature review, the therapeutic course and prognosis were analyzed. Results A male patient, 24 years old, had convulsions after 4-day fever, blood routine, blood biochemistry, coagulation function and infection indexes were basically normal on admission. There was no obvious abnormality in cerebrospinal fluid examination; blood pathogenic microorganism examination suggested that viral infection possibly occur. Electroencephalogram (EEG) showed that the lesions involved the right frontal pole-frontal area-temporal area; cranial magnetic resonance imaging (MRI) suggested that sinusitis and meningeal and hippocampal infections might be present. Although several antiepileptic drugs had been used, the convulsions could not be controlled, after combined with the application of midazolam and atracurium, the convulsions were controlled, in the mean time, antiviral drug, glucocorticoid and immunoglobulin and therapies for prevention of complications were applied. Forty-three days later, the patient's consciousness was recovered and muscle strength was gradually improved. Conclusion The combination of midazolam and atracurium is effective for controlling epileptic activities and alleviating sequelae in patients with SRSE and coma.