Abstracts

RATIONALE: To explore outcome differences between propofol and midazolam therapy for refractory status epilepticus (RSE). METHODS: Retrospective chart review of consecutive patients treated for RSE between 1995 through 1999. RESULTS: We found 14 patients treated primarily with propofol and six with midazolam. Propofol and midazolam therapy achieved 64% and 67% complete clinical seizure suppression, and 78% and 67% electrographic seizure suppression. Overall mortality, although not statistically significant, was higher with propofol (57%) than with midazolam (17%) (p = 0.16). Subgroup mortality data in propofol and midazolam patients based on APACHE II score points did not show statistically significant difference except for propofol treated patients with APACHE II score points ?20 who had a higher mortality (p =0.05). Reclassifying the one patient treated with both agents to the midazolam group, eliminated this statistically significant difference (p =0.22). CONCLUSIONS: In our small sample of RSE patients, propofol and midazolam did not differ in clinical and electrographic seizure control. Seizure control and overall survival rate with the titration goal of electrographic seizure elimination or burst-suppression, rather than latter alone, was similar to previous reports. In RSE patients with APACHE II scores ?20, survival with midazolam may be better than with propofol. A multi-center, prospective, randomized comparison is needed to clarify these data. If comparable efficacy of these agents in seizure control is borne out, tolerance with regard to hemodynamic compromise, complications, and mortality may dictate the choice of RSE agents.