Refractory status epilepticus

Mortality and morbidity associated with status epilepticus (SE) are, to a large extent, determined by the etiology underlying SE and the rapidity with which seizures are controlled.1 Most patients with SE will respond to aggressive treatment protocols that include repeated high doses of phenytoin, phenobarbital, and benzodiazepine. SE refractory to standard treatment protocols may respond to alternative therapies with IV lidocaine or valproic acid, or to continuous infusion of midazolam lorazepam or propofol.2 When these measures fail to control SE, patients may require the induction of coma with pentobarbital.3 A 13-year-old girl with seizures refractory to standard SE protocols, alternative therapeutic strategies, and 4 weeks of pentobarbital coma achieved control of both clinical and electrographic seizures after the administration of ketamine. Case report. A previously healthy 13-year-old girl presented with a 3-day history of muscle aches, fever, and generalized tonic-clonic seizures. She was treated with IV diazepam and loaded with 20 mg/kg phenytoin. SE persisted, and the patient was subsequently loaded with 20 mg/kg phenobarbital. Her seizures persisted despite these measures. Repeated doses of phenobarbital and phenytoin and continuous IV infusion to a maximum dose of 2 mg/kg/hour were ineffective. During the next 12 hours she continued to …