Very high dose phenobarbital for refractory status epilepticus.
BACKGROUND
Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to first, second and third-line therapy. The RSE is associated with high morbidity and mortality. Treatment guidelines of RSE give a spectrum of options, such as, continuous intravenous (i.v.) midazolam (MDL), or continuous i.v. propofol (PRO) as alternatives to phenobarbital (PB) or continuous i.v. pentobarbital (PTB).


OBJECTIVE
To study the efficacy of very-high-dose phenobarbital (VHDPB) for treatment RSE.


METHODS
Retrospective study


METHODS
The authors collected and analyzed data from adult patients who were diagnosed with RSE.


RESULTS
The authors present 10 patients with RSE who were treated with VHDPB. All of them were generalized convulsive status epilepticus (GCSE). Ages ranged from 16-86 years old (mean.: 43 years). PB dosage ranged 40-140 mg/kg/day (mean: 70 mg/kg/day). The duration of status epilepticus (SE) varied widely, ranged 1-44 days (mean: 7 days). PB level ranged 35.29-218.34 ug/mL (mean 88.1 ug/mL). RSE was controlled by VHDPB 70%, 30% were not controlled.


CONCLUSIONS
VHDPB were considered as alternative treatment for RSE.
Tiamkao
Somsak
S
Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. somtia@kku.ac.th
Mayurasakorn
Nattakarn
N
Suko
Panit
P
Jitpimolmard
Suthipun
S
Arunpongpaisal
Suwanna
S
Phuttharak
Warinthorn
W
Auevitchayapat
Narong
N
Vannaprasaht
Suda
S
Tiamkao
Siriporn
S
Phunikhom
Kutcharin
K
Chaiyakum
Aporanee
A
Saengsuwan
Jiamjit
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D017211:Treatment Failure
D000927:Anticonvulsants; D010634:Phenobarbital