Abstracts

RATIONALE: Anesthesia for intractable status epileticus is labor intensive, costly and carries an increased risk for iatrogenic complications. A previous report (Epilepsia 1989; 30:464-71) suggested that IV phenytoin doses [gt]18mg/Kg and diazepam [gt]10 mg/Kg may control status epilepticus not responsive to conventional doses. This study expands on those observations.
METHODS: Fifty-one patients in convulsive status epilepticus were treated with conventional doses of phenytoin (18 mg/Kg) and either diazepam (10 mg) or lorazepam (0.125 mg/Kg), I.V. If there was no response (verified electrographically) the patients received an additional 12mg/kg of phenytoin and diazepam 10 mg or lorazepam 0.125 mg/Kg, IV. If at the end of the second infusion there was no response (by EEG) and patients could safely receive IV pentobabital at that time, this therapy was begun. Otherwise, a third infusion of phenytoin 10mg/Kg and diazepam, up to 10 mg and lorazepam up to 0.125 mg/kg were given, while preparations for anesthesia were being made. Response was measured via EEG.
RESULTS: Thirty-two (63%) patients responded to conventional treatment. Ten patients (20%) were controlled with a total phenytoin dose of 30 mg/Kg and 20 mg. of diazepam or 0.250 mg/kg of lorazepam. Five patients who did not respond to high dose therapy received pentobarbital anesthesia. In four patients, for whom preparations for anesthesia had not been completed at the time the infusions of additional medications ended, received more phenytoin (total: 40 mg/Kg) and diazepam (up to 30 mg) and lorazepam (up to 0.375), status came under control.
CONCLUSIONS: Very high doses of phenytoin and benzodiazepine may obviate the need for anesthesia in status epileticus, reducing the morbidity and high cost inherent to this form of therapy. The very high phenytoin dose finds support in animal data (Epilepsy Res 1994;19:99-110).
[Supported by: Alliance for Epilepsy Research ]