Endosulfan-Induced Prolonged Super-Refractory Status Epilepticus

Abstract

Endosulfan is a highly toxic pesticide that causes hyperstimulation of the central nervous system by antagonizing gamma aminobutyric acid-mediated inhibition. Seizure is the most important manifestation of endosulfan poisoning, frequently progressing to status epilepticus and refractory status epilepticus. Here, we report a recent case of a 64-year-old man with endosulfan-induced super-refractory status epilepticus, which persisted for a remarkably longer period than has been described in previous reports. The patient arrived at the emergency room with continuous generalized tonic-clonic seizures. Electroencephalogram-recorded seizures that persisted even after intravenous administration of lorazepam and antiepileptic drugs. Intravenous anesthetic agents were administered for 9 days to confront the persistently recurring seizures. Immediately after this treatment period, the seizures subsided, and the patient showed marked neurological improvement. After 2 months however, he died of multiple systemic complications. This case report elucidates the importance of aggressive evaluation and management including continuous EEG monitoring in cases of endosulfan-related status epilepticus.

A narrative review of contemporary lethal pesticides: unveiling the ongoing threat of pesticide poisoning

“…Despite this, in the context of convulsions related to acute endosulfan poisoning, the prognosis is generally more favorable compared to seizures resulting from other neurological diseases (116). Therefore, active management including intravenous administration of lorazepam and antiepileptic agents and continuous electroencephalogram monitoring to control seizures is deemed necessary in cases of endosulfan-related status epilepticus (116,117). In conclusion, the persistence of highly toxic pesticides, such as chlorfenapyr, bentazon(e), G-SH, and GAH, in agricultural practices poses a continuous risk of acute pesticide poisoning.…”