Abstracts

RATIONALE: Status epilepticus is a serious,life-threatening condition requring immediate medical attention.Although initial therapies with antiepileptic agents generally terminate seizure activity within 30-60 minutes, patient with refractory status epilepticus(RSE) require additional intervention. High dose pentobarital as been the most commonly prescribed agent for the management of RSE.Pentobarbital coma(PC) has been implemented in adults, but insufficient clinical trial has been administered till now in children. The objection is to evaluate the coherance between the response of PC and neurologic outcome in pediatric RSE patients. METHODS: Twenty-three RSE subjects were enrolled in this study. All subjects could not be controlled by using conventional antiepilptics. Thereafter,pentobarbital was tapered,(tapering rate:0.5mg/kg/12hr) at a minimum of 48hrs of seizure free status. Medical records were retrospectively reviewed for each of the patients' demographic files, etiologies,seizure types, side effects and responses of PC, and neurologic outcomes RESULTS: Out of twenty-three patients, twelve patients(52.2%) were controlled with pentobarbital(responder group). Nine patients(39.1%) relapsed after pentobarbital discontiuation(relapser group), Two(8.7%) were unresponsive to pentobarbital(nonresponder group). The mortality rate of relapser and non-responder group were 90.9%(10/11 patients), whereas the rate for the responder group were 8,3%(1/12patients) (P<0.01). The etiologies of RSE were eight(34.8%) idiopathic group[mortality rate:12.5%(1/8 patients)], one remote symptomatic(survive), fourteen (60.9%) acute symptomatic group[mortality rate:78.6%(11/14patients)].We experienced 3 serious side effects(2hypotension, 1 bradycardia)in neonatal hypoxic ischemic encephalopathy CONCLUSIONS: Failure of seizure control after PC was highly correlated with poor prognosis.The most important predictor of outcome was etiologic factors of RSE. High incidence of serious side effects of pentobarbital could result in neonate and should be treated with caution in neonate.