title: Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety.
abstract: Current management guidelines for refractory status epilepticus (RSE) recommend the use of intravenous continuous anesthetic therapy, but there is little evidence to guide the selection of the most efficacious and safest drug. We conducted a retrospective study to evaluate the efficacy and safety of midazolam versus thiopental for treatment of RSE. Retrospective case-control series of prospectively identified patients treated with midazolam or thiopental for RSE between January 2007 and December 2014. The primary outcome was control of RSE. Secondary outcomes included the rate of adverse events, intensive care unit (ICU) and hospital length of stay, hospital mortality and long-term neurological outcome, assessed with the extended Glasgow outcome scale (GOS-E) at discharge and at six 6 months. A total of 33 patients were included, 19 treated with midazolam and 14 with thiopental. Groups were similar for demographic data, clinical variables, comorbidity and the underlying cause of RSE. The rate of control of SE did not differ between groups (63 vs. 64 %). Adverse events including hypotension (mean arterial pressure <70 mmHg) requiring vasopressors, infections, anemia requiring red blood cells transfusion, leucopenia (<4000/mm(3)), and hyponatremia (<130 mEq/l) were more frequent during thiopental infusion. Furthermore, patients treated with midazolam had a shorter median ICU length of stay (6 vs. 15 days; p = 0.02) and better GOS-E at 6 months (8 [8] vs. 4 [4, 5]; p = 0.01). These findings suggest that continuous midazolam administration is as efficacious as thiopental infusion for the treatment of RSE; however, midazolam was associated with a significantly lower number of adverse events. These findings should be confirmed in larger multicenter trials.
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium.|Department of Neurology, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium.
authors.forename: Flavio
authors.initials: F
authors.lastname: Bellante
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Legros
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium.
authors.forename: Chantal
authors.initials: C
authors.lastname: Depondt
authors.affiliation: Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Créteur
authors.affiliation: Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium.
authors.forename: Fabio Silvio
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium. nicolas.gaspard@erasme.ulb.ac.be.|Division of Clinical Neurophysiology, Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA. nicolas.gaspard@erasme.ulb.ac.be.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gaspard
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008874:Midazolam / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D012189:Retrospective Studies; D013226:Status Epilepticus / Q000188:drug therapy*; D013874:Thiopental / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D013874:Thiopental; D008874:Midazolam
keywords: Barbiturates; Midazolam; Refractory status epilepticus; Status epilepticus; Thiopental