Induction of burst suppression or coma using intravenous anesthetics in refractory status epilepticus.
General anesthetic-induced coma therapy has been recommended for the treatment of refractory status epilepticus (RSE). However, the influence of electroencephalographic (EEG) burst suppression (BS) on outcomes still remains unclear. This study investigated the impact of intravenous anesthetic-induced BS on the prognosis of RSE using a retrospective analysis of all consecutive adult patients who received intravenous anesthetic treatment for RSE at the Seoul National University Hospital between January 2006 and June 2011. Twenty-two of the 111 episodes of RSE were enrolled in this study. Of the 22 RSE patients, 12 (54.5%) were women and 18 (81.4%) exhibited generalized convulsive status epilepticus. Sixteen patients (72.7%) were classified as having acute symptomatic etiology, including three patients with anoxic encephalopathy, and others with remote symptomatic etiology. Only two patients (9.1%) had a favorable Status Epilepticus Severity Score (0-2) at admission. All patients received midazolam (MDZ) as a primary intravenous anesthetic drug for RSE treatment; three (13.6%) received MDZ and propofol, and one (4.5%) received MDZ and pentobarbital. The rates of mortality and poor outcome at discharge were 13.6% (n=3) and 54.5% (n=12), respectively. While BS was achieved in six (27.5%) patients, it was not associated with mortality or poor outcome. Induced BS was associated with prolonged hospital stay in subgroup analysis when excluding anoxic encephalopathy. Our results suggest that induction of BS for treating RSE did not affect mortality or outcome at discharge and may lead to an increased length of hospital stay.
Department of Neurology, Korea University Anam Hospital, Seoul, South Korea.
Bong Su
BS
Kang
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Keun-Hwa
KH
Jung
Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea.
Jeong-Won
JW
Shin
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Jang Sup
JS
Moon
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Jung-Ick
JI
Byun
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Jung-Ah
JA
Lim
Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
Hye Jin
HJ
Moon
Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Young-Soo
YS
Kim
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Soon-Tae
ST
Lee
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea.
Kon
K
Chu
Department of Neurology, Laboratory for Neurotherapeutics, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, College of Medicine, Seoul National University, 101, Daehangno, Chongro-Gu, Seoul 110-744, South Korea. Electronic address: sangkun2923@gmail.com.
Sang Kun
SK
Lee
D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000927:Anticonvulsants / Q000627:therapeutic use; D003128:Coma / Q000139:chemically induced* / Q000175:diagnosis* / Q000503:physiopathology; D004569:Electroencephalography / Q000187:drug effects* / Q000379:methods; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D008874:Midazolam
Burst suppression; Coma; Intravenous anesthetics; Outcome; Refractory status epilepticus