Abstracts

Rationale: Refractory status epilepticus is a common Neurological Emergency with increased mortality and morbidity in developing countries where facilities of intubation, adequate ventilation, Intensive Care Unit and general anesthesia are not always available. Treatments protocols so far with anti epileptic drugs (AEDs) need ICU facilities after failure of AEDs. Aim: Our aim was to look at status in our patients and see the response to two additional drugs in the armamentarium against refractory status before ICU beds could be made available for these patients. Methods: All patients with refractory status epilepticus admitted in Neurology services at AIIMS over a period of Dec 2006 to Feb 2008 were included in the study. The patints had to had have active clinical status epilepticus within an hour or more during presentation. All the patients received Intravenous lorazepam, phenytoin standard plus half loading and did not respond to both these agents. The patients were randomized into two groups based on certain criteria which were mainly to do with the presence or absence of multiorgan dysfunction. Demographic details, reason for delay, etiology precipitating status, ongoing anti epileptic therapy, duration of status and the time taken for cessation along with clinical, EEG and MRI correlates were noted. Out come parameters were analyzed by an independent blinded observer. The duration of hospital stay and anti epileptic drugs given during hospital stay and discharge were noted. Attempt was made to study the correlation of cessation of status and the time taken with the IV anti epileptic agent used. Results: Results: During the study period 72 patients presented with status to the neurological emergeny services, 59 patients with the criteria of refractory status were studied in which 31 patients were given IV Valproate [Group A] and 28 were given IV Leveteracetam [Group B]. This was a prior to availability of ICU beds for these patients. Cessation of status did not happen in 2 patients in each group. Majority of the patients did not require ICU settings despite being classified as refractory. Those requiring ICU care had a grave prognosis with increased morbidity. The most coomon cause for delayed presentation was the lack of awareness to the seriousness of the condition, followed by distance of the patients abode from medical facilities. Conclusions: Refractory status epilepticus can well be controlled with intravenous loading and maintenance of Valproate and Leveteracetam which do not cause respiratory depression, hypotension and need of intubation and ICU care. These must always be considered in developing country scenario where ICU facilities are not always available or while transporting to centers where these facilities are available.