Treatment of Refractory Status Epilepticus

A Randomized Clinical Trial for the Treatment of Refractory Status Epilepticus

The purpose of this study is to determine whether propofol or barbiturates should be preferred in the treatment of status epilepticus (continuous seizure activity) refractory to 2 standard antiepileptic agents.

Refractory status epilepticus (SE) develops in 31%-44% of patients with SE, with a mortality of 16%-23%. Coma induction is advocated for its management. Propofol and barbiturates are the most used agents, but no comparative study has been performed. In consideration of the uncertainty regarding the relative effectiveness, despite several retrospective data, a prospective investigation is needed.

The objective is to assess the effectiveness (SE control, adverse events) of a first course of propofol versus barbiturates in the treatment of refractory SE, in adults with refractory SE not due to cerebral anoxia.

Comparison: Coma induction with standardized doses of propofol or barbiturates titrated towards burst-suppression on EEG, then assessment of the proportion of patients achieving a control of SE.

Inclusion Criteria:

• Patients with refractory status epilepticus not due to cerebral anoxia, needing coma induction for clinical management.

Exclusion Criteria:

• Age < 16 years old.
• Known pregnancy.
• Cerebral anoxia as SE etiology.
• Epilepsia partialis continua (simple partial SE).
• Known intolerance to the study drugs.
• Known mitochondrial disorder, hyperlipidemia, or significant rhabdomyolysis.