Should We Use Anesthetic Drugs for Status Epilepticus that has Failed to Respond to Other Medications?

In the December 6, 2013, early access issue of the journal, Neurology, Drs. Sutter from the University Hospital in Switzerland and other colleagues present an analysis of all intensive care patients with status epilepticus from 2005 to 2011 at a Swiss tertiary academic medical center. These patients were evaluated for the outcome measures of seizure control, their Glasgow Outcome Scale score at discharge, and whether the patient died.

In the study, 171 patients were identified and 37% of these were treated with intravenous anesthetic drugs. The study found the following:

• Mortality was 18%.
• Patients with anesthetic drugs had more infections during status epilepticus and a 2.9-fold relative risk for death independent of possible confounders and without significant effect, modification by different grades of status epilepticus severity and etiologies.
• As intravenous antiepilepsy drugs were used after intravenous anesthetic drugs were used after first and second line drugs failed, there was a correlation between treatment-refractory status and the use of anesthetic drugs leading to insignificant results regarding the risk of these drugs and outcome.
• The investigators concluded that the findings heighten awareness regarding the adverse effects of intravenous anesthetic drugs and that randomized control trials are needed to further clarify the association of intravenous anesthetic drugs with ultimate outcome in patients with status epilepticus.