Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin

P. C. Van Ness

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Seven patients with complex partial or secondarily generalized tonic-clonic status epilepticus (SE) refractory to benzodiazepines (BZDs) and phenytoin (PHT) were treated with pentobarbital (PTB) coma with an EEG burst suppression (BSP) pattern. PTB administered by continous intravenous (i.v.) infusion pump at a loading dose of 6-8 mg/kg in 40-60 min was usually sufficient to produce BSP activity and seizure control. PTB was continued 0-24 h at 1-4 mg/kg/h, adjusted to maintain blood pressure (BP) and BSP. Infusion rate was decreased if systolic BP (SBP) was <90 mm Hg. Normal saline fluid challenge was occasionally used to elevate BP, but in no case was it necessary to discontinue PTB infusion or use pressors. Other antiepileptic drugs (AEDs) were maintained at therapeutic levels for chronic seizure protection. Seizures were stopped in all cases. Four patients attained premorbid neurologic status, two patients briefly survived in vegetative states with recurring seizures after PTB withdrawal, and one patient died of asystole after receiving PTB for 7 h. Patients who had poor outcomes had prolonged seizures (16 h to 3 weeks) before institution of PTB anesthesia, and all had significant underlying central nervous system (CNS) pathology. PTB-induced BSP appears to be safe and effective for refractory SE if it is started soon after failure of a BZD and PHT. Ultimate prognosis depends on SE etiology.

Original languageEnglish (US)
Pages (from-to)61-67
Number of pages7
JournalEpilepsia
Volume31
Issue number1
StatePublished - 1990

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Status Epilepticus
Phenytoin
Pentobarbital
Benzodiazepines
Electroencephalography
Seizures
Blood Pressure
Therapeutics
Persistent Vegetative State
Infusion Pumps
Coma
Heart Arrest
Intravenous Infusions
Anticonvulsants
Nervous System
Anesthesia
Central Nervous System
Pathology

Keywords

  • Epilepsy
  • Pentobarbital
  • Status epilepticus

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin. / Van Ness, P. C.

In: Epilepsia, Vol. 31, No. 1, 1990, p. 61-67.

Research output: Contribution to journalArticle

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