title: Propofol treatment of refractory status epilepticus: a study of 31 episodes.
abstract: OBJECTIVE
  Refractory status epilepticus (RSE) is a critical medical condition with high mortality. Although propofol (PRO) is considered an alternative treatment to barbiturates for the management of RSE, only limited data are available. The aim of this study was to assess PRO effectiveness in patients with RSE.
  
  
  METHODS
  We retrospectively considered all consecutive patients with RSE admitted to the medical intensive care unit (ICU) between 1997 and 2002 treated with PRO for induction of EEG-monitored burst suppression. Subjects with anoxic encephalopathy showing pathological N20 on somatosensory evoked potentials were excluded.
  
  
  RESULTS
  We studied 31 RSE episodes in 27 adults (16 men, 11 women; median age, 41.5 years). All patients received PRO, and six also subsequently thiopental (THP). Clonazepam (CZP) was administered with PRO, and other antiepileptic drugs (AEDs) concomitant with PRO and THP. RSE was successfully treated with PRO in 21 (67%) episodes and with THP after PRO in three (10%). Median PRO injection rate was 4.8 mg/kg/h (range, 2.1-13), median duration of PRO treatment was 3 days (range, 1-9), and median duration of ICU stay was 7 days (range, 2-42). In 24 episodes in which the patient survived, shivering after general anesthesia was seen in 10 episodes, transient dystonia and hyperlipemia in one each, and mild neuropsychological impairment in five. The seven deaths were not directly related to PRO use.
  
  
  CONCLUSIONS
  PRO administered with CZP was effective in controlling most of RSE episodes, without major adverse effects. In this setting, PRO may therefore represent a valuable alternative to barbiturates. A randomized trial with these drug classes could definitively assess their respective role in RSE treatment.
authors.affiliation: Service de Neurologie, Lausanne, Switzerland.
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Marc D
authors.initials: MD
authors.lastname: Reichhart
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: Paul-André
authors.initials: PA
authors.lastname: Despland
authors.forename: Julien
authors.initials: J
authors.lastname: Bogousslavsky
mesh_terms: D000328:Adult; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use; D002998:Clonazepam / Q000627:therapeutic use; D003128:Coma / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D004569:Electroencephalography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D015742:Propofol / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D013874:Thiopental / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D002998:Clonazepam; D013874:Thiopental; D015742:Propofol