Highlights
- •There is no strong evidence for the use of anesthetics in treating status epilepticus.
- •Randomized trials in this context are lacking.
- •Recently, the use of anesthetics in treating status epilepticus was associated with death.
- •These results call for caution in the use of anesthetics in treating status epilepticus.
- •The rationale and conflicting implications of anesthetics are discussed.
Abstract
Status epilepticus refractory to first-line and second-line antiepileptic treatments
challenges neurologists and intensivists as mortality increases with treatment refractoriness
and seizure duration. International guidelines advocate anesthetic drugs, such as
continuously administered high-dose midazolam, propofol, and barbiturates, for the
induction of therapeutic coma in patients with treatment-refractory status epilepticus.
The seizure-suppressing effect of anesthetic drugs is believed to be so strong that
some experts recommend using them after benzodiazepines have failed. Although the
rationale for the use of anesthetic drugs in patients with treatment-refractory status
epilepticus seems clear, the recommendation of their use in treating status epilepticus
is based on expert opinions rather than on strong evidence. Randomized trials in this
context are lacking, and recent studies provide disturbing results, as the administration
of anesthetics was associated with poor outcome independent of possible confounders.
This calls for caution in the straightforward use of anesthetics in treating status
epilepticus. However, there are still more questions than answers, and current evidence
for the adverse effects of anesthetic drugs in patients with status epilepticus remains
too limited to advocate a change of treatment algorithms.
In this overview, the rationale and the conflicting clinical implications of anesthetic
drugs in patients with treatment-refractory status epilepticus are discussed, and
remaining questions are elaborated.
This article is part of a Special Issue entitled “Status Epilepticus”.
Keywords
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Article info
Publication history
Published online: March 25, 2015
Accepted:
February 28,
2015
Received in revised form:
February 26,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
