Literature review, case report, and expert discussion of prolonged refractory status epilepticus.
We report the case of a 30-year-old woman with severe, prolonged refractory status epilepticus requiring more than 6 months of iatrogenic coma. Opinions on prognosis and clinical management were solicited from a number of experienced neurointensivists and epileptologists at multiple time-points during the clinical course. The ensuing discussion, annotated with references, is presented here. Several experts commented on isolated cases of young patients with encephalitis requiring up to 2-3 months of iatrogenic coma, yet still having good outcomes. Treatments discussed include ketamine, gammaglobulin, plasmapheresis, steroids, adrenocorticotropic hormone, very high-dose phenobarbital, isoflurane, lidocaine, electroconvulsive therapy, ketogenic diet, hypothermia, magnesium, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, and neurosurgery. The patient eventually suffered a cardiac arrest but was resuscitated as requested by the family. Seizures then stopped, and the patient has remained in a persistent vegetative state since.
Robakis
T K
TK
Comprehensive Epilepsy Center, Columbia University, New York, NY 10032, USA.
Hirsch
L J
LJ
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D046690:Deep Brain Stimulation; D005260:Female; D006801:Humans; D018458:Persistent Vegetative State / Q000209:etiology*; D011379:Prognosis; D011859:Radiography; D013226:Status Epilepticus / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*
D000927:Anticonvulsants