ABSTRACT
Status epilepticus (SE) is one of the common neurological emergencies in adults and for which morbidity and mortality are high and associated with either inappropriate management or underlying diseases. Forty SE patients were included (23 men; 17 women) between 18 and 86 years of age. Generalized convulsive status epilepticus (GCSE) was most common (34 events, 85%) vs. non-convulsive status epilepticus (NCSE) (6 events, 15%). Nineteen patients (47.5%) had previously diagnosed neurological disorders. Antiepileptic drug withdrawal, encephalitis and alcohol-related illness were the common causes of SE. Thirteen patients (32.5%) developed refractory status epilepticus. Improper management was found in 23 events (57.5%). Outcomes of SE included death (14, 35%), complete recovery (14, 35%) and partial recovery (12, 30%). Of the patients who experienced improper management 43.5% died over against the 23.5% who died despite proper management. To improve the outcome of SE, a public information campaign on the management ofSE is needed
Subject(s)
Medical Errors/statistics & numerical data , Status Epilepticus/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Cohort Studies , Female , Hospitals, University , Humans , Male , Middle Aged , Retrospective Studies , Status Epilepticus/diagnosis , Status Epilepticus/mortality , Thailand , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to first, second and third-line therapy. The RSE is associated with high morbidity and mortality. Treatment guidelines of RSE give a spectrum of options, such as, continuous intravenous (i.v.) midazolam (MDL), or continuous i.v. propofol (PRO) as alternatives to phenobarbital (PB) or continuous i.v. pentobarbital (PTB). OBJECTIVE: To study the efficacy of very-high-dose phenobarbital (VHDPB) for treatment RSE. STUDY DESIGN: Retrospective study MATERIAL AND METHOD: The authors collected and analyzed data from adult patients who were diagnosed with RSE. RESULTS: The authors present 10 patients with RSE who were treated with VHDPB. All of them were generalized convulsive status epilepticus (GCSE). Ages ranged from 16-86 years old (mean.: 43 years). PB dosage ranged 40-140 mg/kg/day (mean: 70 mg/kg/day). The duration of status epilepticus (SE) varied widely, ranged 1-44 days (mean: 7 days). PB level ranged 35.29-218.34 ug/mL (mean 88.1 ug/mL). RSE was controlled by VHDPB 70%, 30% were not controlled. CONCLUSION: VHDPB were considered as alternative treatment for RSE.
