Prolonged coma from refractory status epilepticus.
OBJECTIVE
Status epilepticus is a life-threatening medical condition. In its most severe form, refractory status epilepticus (RSE) seizures may not respond to first and second-line anti-epileptic drugs. RSE is associated with a high mortality and significant medical complications in survivors with prolonged hospitalizations.


METHODS
We describe the clinical course of RSE in the setting of new onset lupus in a 31-year-old male who required prolonged barbiturate coma.


RESULTS
Seizure stopped on day 64 of treatment. Prior to the resolution of seizures, discussion around withdrawal of care took place between the physicians and patient's family. Medical care was continued because of the patient's age, normal serial MRI studies, and the patient's reversible medical condition.


CONCLUSIONS
Few evidence-based data exist to guide management of RSE. Our case emphasizes the need for continuous aggressive therapy when neuroimaging remains normal.
Dara
Saqib I
SI
Critical Care Service, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Tungpalan
Lori A
LA
Manno
Edward M
EM
Lee
Vivien H
VH
Moder
Kevin G
KG
Keegan
Mark T
MT
Fulgham
Jimmy R
JR
Brown
Daniel R
DR
Berge
Keith H
KH
Whalen
Francis X
FX
Roy
Tuhin K
TK
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology; D003128:Coma / Q000209:etiology*; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D012032:Refractory Period, Electrophysiological; D012720:Severity of Illness Index; D013226:Status Epilepticus / Q000150:complications* / Q000188:drug therapy / Q000209:etiology*
D000927:Anticonvulsants