title: Mega-dose phenobarbital therapy for super-refractory status epilepticus.
abstract: OBJECTIVE
  To evaluate the efficacy and safety of mega-dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super-refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients.
  
  
  METHODS
  Adult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events. SRSE outcome was divided into six categories: successful therapy, initial failure, breakthrough seizures, withdrawal seizures, intolerable side effects, and death during treatment.
  
  
  RESULTS
  Ten adult patients with SRSE received MDPB. Median age at seizure onset was 38 years (range: 18-59), and half were male. All patients had no history of seizures and had symptoms suggestive of viral encephalitis. Median duration of status epilepticus was 17.5 days (range: 6-60) and anaesthetics were used for a median of 14.0 days (range: 2-54) before MDPB. Successful control of SRSE was achieved in half of the patients, however, only one of ten patients was able to fully recover at discharge. Median duration of the MDPB was 45.5 days and the maximum serum phenobarbital level reached a median of 151.5 μg/ml. Patients with successful MDPB therapy had normal brain imaging (80% vs. 0%; p=0.048) and better functional outcome at discharge and after three months of follow-up. Infection was the most critical complication, along with cardiorespiratory depression.
  
  
  CONCLUSIONS
  MDPB is a therapeutic option for control of SRSE when other choices are exhausted.
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jung-Ick
authors.initials: JI
authors.lastname: Byun
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jun-Sang
authors.initials: JS
authors.lastname: Sunwoo
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jangsup
authors.initials: J
authors.lastname: Moon
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jung-Ah
authors.initials: JA
authors.lastname: Lim
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jin-Sun
authors.initials: JS
authors.lastname: Jun
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Han Sang
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Woo-Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Seoul National University Hospital.
authors.forename: Doo Young
authors.initials: DY
authors.lastname: Lee
authors.affiliation: Seoul National University Hospital.
authors.forename: Daejong
authors.initials: D
authors.lastname: Jeon
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Soon-Tae
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Keun-Hwa
authors.initials: KH
authors.lastname: Jung
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ki-Young
authors.initials: KY
authors.lastname: Jung
authors.affiliation: Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage / Q000627:therapeutic use*; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010634:Phenobarbital / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D010634:Phenobarbital
keywords: management; mega-dose phenobarbital; outcome; super-refractory status epilepticus