Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings.
OBJECTIVE
We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels.


METHODS
Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol.


RESULTS
Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) than with high-dose barbiturate therapy (82%). The time from initiation of high-dose barbiturate therapy to attainment of control of RSE was longer (123 min) than the time to attainment of seizure control in the group receiving propofol (2.6 min, p = 0.002). Plasma concentrations of propofol associated with control of SE were 14 microM +/- 4 (2.5 microg/ml). Recurrent seizures were common when propofol infusions were suddenly discontinued but not when the infusions were gradually tapered.


CONCLUSIONS
If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.
Stecker
M M
MM
Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Kramer
T H
TH
Raps
E C
EC
O'Meeghan
R
R
Dulaney
E
E
Skaar
D J
DJ
D000328:Adult; D000368:Aged; D001463:Barbiturates / Q000008:administration & dosage / Q000627:therapeutic use; D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology; D007260:Infusion Pumps; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage / Q000627:therapeutic use; D010672:Phenytoin / Q000008:administration & dosage / Q000627:therapeutic use; D015742:Propofol / Q000097:blood / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013226:Status Epilepticus / Q000097:blood / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
D001463:Barbiturates; D010672:Phenytoin; D015742:Propofol; D010634:Phenobarbital