A case of status epilepticus.

Abstract

SummaryA case of status epilepticus which was refractory to conventional anticonvulsants is described. The total dosage of thiopentone necessary to control the convulsions is greater than that previously recorded. The use of regular plasma estimation of thiopentone levels, and of cortical monitoring with the Cerebral Function Monitor (Ormed Engineering) is described, and is recommended where anticonvulsants are used for prolonged control of status epilepticus and in dosages greater than is common practice. Key words Brain; convulsions.Status epilepticus is a life-threatening condition, in which one convulsion follows another without recovery of consciousness. During the convulsions, cerebral oxygen and glucose requirements are increased, and, unless the convulsions are arrested, pyrexia or hyperpyrexia, hypotension, hypoglycaemia and the enhancement of cerebral arteriovenous oxygen and carbon dioxide differences will all combine to deepen the coma, and make death inevitable.'Treatment of status epilepticus is directed towards arresting the convulsions whilst maintaining adequate oxygenation and vital organ function. Artificial ventilation and muscle relaxation may be of benefit in this situation: but the use of muscle relaxants may prevent neuromuscular conduction and hence the clinically recognisable clonic phase of a fit. It is of advantage, therefore, to monitor cortical activity in order to show when the cerebral epileptic discharge is under control.A case description follows of a patient in whom conventional doses of anticonvulsants had failed to suppress the convulsions, and who required artificial ventilation. The use of cortical monitoring enabled the dosage of anticonvulsant to be pursued and adjusted to the point where cortical epileptic activity ceased. The dosage required was far in excess of expectation or previous experience. Case historyA 65-year-old man suffering from intermittent haematuria was admitted to hospital as an emergency following the passage of blood and clotsper urethram.The patient had a %-year history of epilepsy, and in 1956 he sustained a left-sided fracture of the skull and extradural haematoma following an epileptic attack. Since that time he had had several admissions to hospital for status epilepticus.