If seizures continue, consider administering general anesthesia with medications such as propofol, midazolam, or pentobarbital. Ketamine infusion can alternatively (or additionally) be used in the treatment of refractory status epilepticus, with some evidence of safety and efficacy.
What is the best treatment for refractory status epilepticus?
Open in a separate window RSE: refractory status epilepticus Pharmacological treatment may be supported and potentiated by non-pharmacological therapeutic strategies; however, the latter mostly represent ultima ratioapproaches in cases of extremely refractory SE.
What is refractory status epilepticus (RSE)?
Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. RSE should be treated promptly to prevent morbidity and mortality; however, scarce evidence is available to support the choice of specific treatments.
What is the role of NMDA in the treatment of status epilepticus?
N-methyl-D-asparate receptor antagonists abolish the maintenance phase of self-sustaining status epilepticus in rat. Neurosci Lett. 1999;265(3):187–90. [PubMed] [Google Scholar] 30. Kapur J, Lothman EW. NMDA receptor activation mediates the loss of GABAergic inhibition induced by recurrent seizures. Epilepsy Res. 1990;5(2):103–11.
Which anesthetics are used in the treatment of restless ears syndrome (RSE)?
Other anesthetics may be used sequentially in patients suffering from very long-lasting RSE, in alternation or combination with midazolam, propofol, or barbiturates.
How is refractory status epilepticus treated?
Management of refractory status epilepticus involves treatment of an underlying etiology in addition to intravenous anesthetics and antiepileptic drugs. Alternative treatment options including diet therapies, electroconvulsive therapy, and surgical resection in case of a focal lesion should be considered.
Which medication has been effective in treating status epilepticus that is refractory to phenobarbital?
Lorazepam is the most commonly used agent, used at a dose of 0.1 mg/kg given in dose of 2 mg/min to a maximum of 8 mg. Lorazepam was shown to be successful in 64.9% patients as the first line compared to 58.2% success with phenobarbital and 55.8 % with Diazepam plus Phenytoin.
Which of the following is the first drug of choice for status epilepticus?
Diazepam. Diazepam is one of the drugs of choice for first-line management of status epilepticus.
Can propofol be used in status epilepticus?
Propofol is used for treating refractory status epilepticus, which has high rate of mortality. Propofol infusion syndrome is a rare but often fatal syndrome, characterized by lactic acidosis, lipidemia, and cardiac failure, associated with propofol infusion over prolonged periods of time.
What is refractory status of epilepticus?
Refractory status epilepticus (RSE) can be defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. RSE should be treated promptly to prevent morbidity and mortality; however, scarce evidence is available to support the choice of specific treatments.
Which medication would be given IV for status epilepticus?
In the initial therapy phase, a benzodiazepine (specifically IM midazolam, IV lorazepam, or IV diazepam) is recommended as initial therapy. In the second phase, options include IV fosphenytoin, valproic acid, or levetiracetam. If none of these is available, IV phenobarbital is a reasonable alternative.
Which drug is used in status epilepticus?
The benzodiazepines are some of the most effective drugs in the treatment of acute seizures and status epilepticus. The benzodiazepines most commonly used to treat status epilepticus are diazepam (Valium), lorazepam (Ativan), and midazolam (Versed).
Which sedative and hypnotic is used in status epilepticus?
Lorazepam (Ativan) Lorazepam is preferred by most neurologists for treatment of SE because of its more prolonged CNS action.
Which medication would the nurse expect to administer for a patient with status epilepticus?
Lorazepam is considered the benzodiazepine of choice for the treatment of individual seizures and SE.
Why is propofol used for seizures?
The effects of propofol on epileptic discharge and seizure activity may be related to its uniform depressant action on the central nervous system, to a potentiation of γ-aminobutyric acid-mediated pre- and postsynaptic inhibition by enhancing inward γ-aminobutyric acid A Cl − currents, and by decreasing the release of ...
Which of the following sedative can be used clinically for seizure?
We conclude that propofol sedation can be used for patients with epilepsy undergoing temporal lobectomy under local anesthesia. Propofol has an advantage over two other short-acting drugs, methohexital and alfentanil, in that it does not produce any "false" spikes or electrographic seizures in this setting.
How do you titrate midazolam for status epilepticus?
1) Midazolam (good choice if BP unstable) Load 0.2mg/kg IV. Repeat q5mins until szs stop (max load 2mg/kg) Maint. infusion 0.1--- 2 mg/kg/hr 2) Propofol Load 2mg/kg IV. Titrate infusion to stop seizures or induce burst suppression (currently no evidence to guide best depth / duration of suppression).