Refractory Status Epilepticus Treatment

There is a lack of consensus upon it’s semantic definition of whether it is status epilepticus that continues despite T/T with benzodiazepine. One epileptic medication is lorazepam plus phenytoin. Others regard refrectomy status epilepticus as a feature of benzodiazepine and antiepileptic medication i.e. lorazepam plus phenytoin plus phenobarb. All patient of refractory status epilepticus require continuous EEG monitoring. There are three main agents used in the treatment of Refractory Status Epilepticus (RSE). These include thiopental midazolam and propofol. RSE was shown to result in mortality in 35 % cases, 39.13 % of patients were left with severe neurological deficits while another 13% had mild neurological deficits.

A Case Study

A 3 year old boy with history of regression of milestones was referred to Shalby Indore with a prodrome of headache, vomiting and swelling all over body for 5-6 days. He was admitted in other setup with status epilepticus, but seizures were not controlled at the time of admission and the child was in comatose state with refractomy multifocal and generalized seizure, which required admission to intensive care unit & administration of antiepilepticus and general Anaesthetics. The child was intubated, was given ventilator support with IV midazolam and IV thiopental infusions were started along with blood investigations. The patient was intitally treated with acyclovir and antibacterial. A provisional diagnosis of inborn error of metabolism *mitochondirial encephalopathy) was made. Due to acute onset of infection mitochondrial cocktail therapy was started i.e. high dosage of Vitamins, Coq, Carnisure and Ketogenic diet. The patient was also given packed cell and FFP due to severe anemia and deranged coagulation profile.

Gradually the child started becoming neurologically and thermodynamically stable after 10 days of ventilator and lonotropes support were gradually withdrawn. IV anticonvulsant (thiopental & Midazolam Infusion) were tapered & shifted to IV gardenal, IV fosdin, IV levipril & also tablet toperamade, which later changed to anticonvulsants. Clinically & EEG wise , the convulsions were stopped completely and he is now being discharged with oral antiepilepticus and Mitochondrial cocktail therapy.

The plan of workup for the etiology of status of epilepticus was undertaken which had been normal so far which comprises of TMS and MR spectroscopy TPO antibody. The parents have been advised to follow-up regularly with pending reports of urinary organic acid.

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