title: Management of refractory status epilepticus at a tertiary care centre in a developing country.
abstract: BACKGROUND
  Refractory status epilepticus (RSE) is a common Neurological Emergency with increased mortality and morbidity in developing countries where facilities of intubation, adequate ventilation, Intensive Care Units (ICUs) and general anaesthesia are not ubiquitously available. Treatment protocols use antiepileptic drugs (AEDs) and need ICU facilities after failure of standard AEDs. Our aim was to see the response to two additional drugs in the armamentarium against refractory status, that is, valproate and levetiracetam.
  
  
  METHODS
  Patients with generalized RSE admitted in neurology and neurosurgery services at AIIMS during December 2006 to June 2008 were included in the study. The patients were allotted to two groups based on certain criteria. Demographic details, reason for delay, etiology precipitating status, ongoing AEDs therapy, duration of status, the time taken for cessation along with clinical, EEG and MRI correlates were noted. Outcome parameters were analyzed by an independent blinded observer.
  
  
  RESULTS
  82 patients with RSE were studied out of which 41 patients were given IV valproate (Group A) and 41 patients were given IV levetiracetam (Group B). Cessation of status failed in 13 patients in valproate group and 11 patients in levetiracetam group. Majority of the patients did not require ICU settings despite being classified as refractory.
  
  
  CONCLUSIONS
  RSE can be controlled with intravenous loading and maintenance of valproate or levetiracetam which do not cause respiratory depression, hypotension, need of intubation and ICU care. These must always be considered in a developing country scenario where ICU facilities are not always available or while transporting to centres where these facilities are available.
authors.affiliation: Department of Neurology, All India Institute of Medical Sciences, New Delhi 110029, India. manjari.tripathi@gmail.com
authors.forename: Manjari
authors.initials: M
authors.lastname: Tripathi
authors.forename: Deepti
authors.initials: D
authors.lastname: Vibha
authors.forename: Navita
authors.initials: N
authors.lastname: Choudhary
authors.forename: Kameshwar
authors.initials: K
authors.lastname: Prasad
authors.forename: M V Padma
authors.initials: MV
authors.lastname: Srivastava
authors.forename: Rohit
authors.initials: R
authors.lastname: Bhatia
authors.forename: Sarat P
authors.initials: SP
authors.lastname: Chandra
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D003906:Developing Countries; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D000077287:Levetiracetam; D008297:Male; D010889:Piracetam / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013226:Status Epilepticus / Q000188:drug therapy* / Q000453:epidemiology*; D016896:Treatment Outcome; D014635:Valproic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D014635:Valproic Acid; D010889:Piracetam