Efficacy of Topiramate in Refractory Status Epilepticus.
Abstract number :
2.195
Submission category :
Year :
2001
Submission ID :
2846
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M. Kahriman, MD, Neurology, University of Michigan, Ann Arbor, MI; E. Passaro, MD, Neurology, University of Michigan, Ann Arbor, MI; D.N. Minecan, MD, Neurology, University of Michigan, Ann Arbor, MI; E. Kutluay, MD, Neurology, University of Michigan, Ann
RATIONALE: Status Epilepticus (SE) is associated with significant morbidity and mortality and requires urgent medical intervention. Many protocols have been used to treat this condition including benzodiazepines, phenytoin, barbiturates, and general anesthesia. Although these agents are often successful in terminating seizure activity, some patients remain refractory. We report the response to topiramate in 4 patients with refractory SE.
METHODS: We reviewed the SE database at the University of Michigan Medical Center and identified four patients with refractory SE who were treated with topiramate. All four patients failed to respond to treatment with benzodiazepines, phenytoin and required treatment with high dose phenobarbital, midazolam or pentobarbital. Refractory SE was defined as persistent intermittent electrographic or clinical seizures or recurrence of seizures following attempts to taper those drugs. Additional treatment with topiramate was administered by nasogastric tube. All patients were continuously monitored by 21-channel digital EEG machines and the diagnosis of status was made by a board certified neurophysiologist.
RESULTS: Two of the patients were children (ages 34 months and 11 years) and two were adults (21 years and 61 years). The two adults failed to respond to topiramate administered at daily doses of 800 mg and 600 mg, respectively. The response of the two pediatric patients was as follows:
Case 1: NH is a 34-month-old boy with a history of schizencephaly, static encephalopathy, hydrocephalus and seizures who developed refractory partial SE despite treatment with benzodiazepines, phenytoin, phenobarbital, pentobarbital, valproate, midazolam, and general anesthesia with isoflurane. The addition of topiramate at 6 mg/Kg resulted in resolution of SE.
Case 2: DT is an11-year-old girl with aplastic anemia who developed a pulmonary hemorrhage and cardiopulmonary arrest requiring resuscitation. Following extubation, she developed mental status fluctuations and her EEG showed multifocal partial SE that was refractory to treatment with benzodiazepines, phenytoin, and high dose phenobarbital. The addition of topiramate at 5 mg/Kg resulted in resolution of SE.
CONCLUSIONS: These case reports support the potential usefulness of topiramate in children with refractory SE. Although no parental formulation is available, this drug can be administered orally through a nasogastric tube. Those results will need to be confirmed in a larger series of pediatric patients with refractory SE.