Management of Super-Refractory Status Epilepticus with Isoflurane and Hypothermia

Abstract

Super-refractory status epilepticus (SRSE) is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, and includes those cases in which epilepsy is recurrent upon treatment reduction. We describe the presentation and successful management of a male patient with SRSE using the inhaled anesthetic isoflurane, and mild hypothermia (HT). The potential utility of combined HT and volatile anesthesia is discussed.

Burden of illness for super-refractory status epilepticus patients

“…Second, the observed LOS using claims data might be significantly different from the observed LOS in smaller cohort studies at academic centers [7][8][9]14 . The recent literature suggests that LOS have significant within-hospital and betweenhospital variance.…”

“…In addition to anesthetics and AEDs, there is a wide range of adjunctive treatments used to manage SRSE in the ICU. These include ketamine, mild hypothermia, ketogenic diet, pyridoxine infusions (pediatrics), magnesium sulfate infusions, immunotherapy (including steroids), and stiripentol 6,7,[12][13][14][15][16] .…”

Successful Use of Therapeutic Hypothermia for Refractory Nonconvulsive Status Epilepticus

“…The absence of additional sedative drugs, except for remifentanil hydrochloride, during hypothermia maintenance indicates that TH itself may have controlled his refractory NCSE. Although TH has been used as adjunct therapy for patients with refractory epilepsy and SE, 8 , 11 , 12 patients with refractory convulsive SE may require sedative drugs to control shivering and maintain hypothermia. Simultaneous administration of sedative drugs limits the ability to evaluate the effects of hypothermia alone.…”

Treatment of Super-Refractory Status Epilepticus

“…Isoflurane and hypothermia have been used in combination, resulting in mild synergism for lowering body temperature and therapeutic efficacy in seizure management [39].…”