Abstracts

Rationale: The efficacy of topiramate use in refractory status epilepticus (RSE) is not well described. We sought to determine whether topiramate demonstrated significant efficacy in patients treated for RSE with regard to: 1) termination of status epilepticus (SE) and 2) final disposition of the patient. Methods: We performed a retrospective analysis of patients identified as having RSE between 2003-2008 from our status epilepticus database to further describe our patient characteristics and outcome variables as well as the efficacy of high-dose topiramate in this population using frequency and descriptive analysis. Results: Data from 17 patients (mean age 52.5 years (19-81)) with RSE from our database who were given high-dose topiramate were evaluated for patient characteristics and outcome variables. Within our group, 52.9% had a history of seizures and 58.8% were in generalized status epilepticus. The majority of patients (46.1%) had non-structural etiologies identified versus 35.0% with structural etiologies and 17.6% idiopathic. In 82.4% (14/17) of the patients, documentation of cessation of status RSE without continuous intravenous anesthetics was within 6 days (10 patients in the first 3 days) of high-dose topiramate initiation. Most patients (82.4%) received topiramate dosing of either 100 mg every 4 or 6 hours; 2 of these patients were given an initial single loading dose prior to the scheduled dosing. Disposition to home was documented in 4/17 (23.5%) patients, to in-patient rehabilitation in 2/17 (11.8%), and to either skilled nursing or long-term acute care facilities in 8/17 (47.0%). Three patients died in our group: in 2 patients, care was withdrawn because of prolonged medical complications, and 1 patient had respiratory arrest following extubation. In all three patients, there was documentation of seizure cessation prior to death. Conclusions: In our experience, topiramate appears to be a viable option in the treatment of RSE. This may be related to its multiple mechanisms of action. A prospective, randomized study would be warranted to further investigate the efficacy of high-dose topiramate in SE and RSE.