title: Palliative sedation for status epilepticus in a patient with progressive multifocal leukoencephalopathy.
abstract: Palliative sedation is defined as the use of sedative drugs in order to reduce the patient's consciousness in case of refractory symptoms. The most used drug is midazolam, a benzodiazepine with a short half-life administered either intravenously or subcutaneously. We discuss on a clinical case requiring an exceptionally high dosage of midazolam-up to 160 mg iv daily-to achieve palliative sedation. The patient was an HIV positive 29-year-old male who was suffering from progressive multifocal leukoencephalopathy complicated by a refractory status epilepticus and who was suspected of previous benzodiazepines and opioid abuse. In such situations of a suffering brain doses of midazolam to achieve symptom control may be much higher than expected.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Cancelli
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dubra
authors.forename: Gilbert B
authors.initials: GB
authors.lastname: Zulian
mesh_terms: D000328:Adult; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008874:Midazolam / Q000627:therapeutic use*; D010166:Palliative Care / Q000379:methods; D013226:Status Epilepticus / Q000150:complications* / Q000188:drug therapy*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: midazolam; palliative; progressive multifocal leukoencephalopathy; sedation; status epilepticus