Literature review, case report, and expert discussion of prolonged refractory status epilepticus

T. K. Robakis, L. J. Hirsch

Research output: Contribution to journalArticlepeer-review

77 Scopus citations

Abstract

We report the case of a 30-year-old woman with severe, prolonged refractory status epilepticus requiring more than 6 months of iatrogenic coma. Opinions on prognosis and clinical management were solicited from a number of experienced neurointensivists and epileptologists at multiple time-points during the clinical course. The ensuing discussion, annotated with references, is presented here. Several experts commented on isolated cases of young patients with encephalitis requiring up to 2-3 months of iatrogenic coma, yet still having good outcomes. Treatments discussed include ketamine, gammaglobulin, plasmapheresis, steroids, adrenocorticotropic hormone, very high-dose phenobarbital, isoflurane, lidocaine, electroconvulsive therapy, ketogenic diet, hypothermia, magnesium, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, and neurosurgery. The patient eventually suffered a cardiac arrest but was resuscitated as requested by the family. Seizures then stopped, and the patient has remained in a persistent vegetative state since.

Original languageEnglish
Pages (from-to)35-46
Number of pages12
JournalNeurocritical Care
Volume4
Issue number1
DOIs
StatePublished - Feb 2006
Externally publishedYes

Keywords

  • ACTH
  • Encephalitis
  • Flavivirus
  • Iatrogenic coma
  • Isoflurane
  • Ketamine
  • Magnesium
  • Midazolam
  • Pentobarbital
  • Phenobarbital
  • Prognosis
  • Propofol
  • Refractory status epilepticus
  • Seizures

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