Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane.
BACKGROUND
Refractory status epilepticus (RSE) is defined as continued seizures after 2 or 3 antiepileptic drugs have failed. Several intravenous agents have been used for RSE; however, problems occur with their toxicity and/or effectiveness.


OBJECTIVE
To report our experience with inhalational anesthesia (IA) in patients who were refractory to other antiepileptic drugs.


METHODS
Retrospective review during a 4-year period of patients with RSE treated with isoflurane and/or desflurane.


METHODS
Efficacy of IA on therapy in terminating RSE.


RESULTS
Seven patients (4 male) aged 17 to 71 years received 7 to 15 (mean, 10) antiepileptic drugs in addition to IAs. The IAs were initiated after 1 to 103 (mean, 19) days of RSE and were used for a mean +/- SD 11 +/- 8.9 days. All patients received isoflurane, and 1 patient in addition received desflurane anesthesia 21 days after the onset of RSE for a total of 19 days. Regardless of seizure type, isoflurane and desflurane consistently stopped epileptic discharges with adequate, sustained electroencephalographic burst suppression within minutes of initiating IA therapy. Four patients had good outcomes, 3 died (1 of acute hemorrhagic leukoencephalitis, 1 of bowel infarction, and 1 of toxic encephalopathy, who remained in a persistent vegetative state until death 5.5 months after the onset of seizures). Complications during IA therapy included hypotension (7/7), atelectasis (7/7), infections (5/7), paralytic ileus (3/7), and deep venous thrombosis (2/7). No patient developed renal or hepatic dysfunction.


CONCLUSIONS
Isoflurane and desflurane adequately suppressed RSE in all cases. Complications were common, but mortality and long-term morbidity were related to the underlying disease and duration of RSE. Prolonged use of isoflurane and desflurane is well tolerated.
Mirsattari
Seyed M
SM
Department of Clinical Neurological Sciences, University of Western Ontario, London, Canada.
Sharpe
Michael D
MD
Young
G Bryan
GB
D000293:Adolescent; D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D000077335:Desflurane; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy* / Q000378:metabolism
D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane