[P1-102] Pediatric Super-Refractory Status Epilepticus: Case Series
[Introduction]
Super refractory status epilepticus (SRSE) is defined as status epilepticus that continues 24 hours or more after the onset of anaesthesia, including those cases in which the status epilepticus recurs on the reduction or withdrawal of anaesthesia, appropriate therapy of these cases is poorly studied.
[Cases]
Case 1, was a 4-year-old girl with tuberculous meningoencephalitis. Patient was referred because of uncontrolled seizures, phenobarbital injection was already given. In our hospital, patient suffered SRSE and was treated with diazepam, phenytoin and phenobarbital, consecutively, but the seizure remained. Laboratory revealed hypokalemia and hypoalbuminemia. Thus, midazolam was administered for 2 months, combined with propofol. Due to dyslipidemia condition, propofol was substituted with ketamin. After 2 months, SRSE was controlled but occasional seizures still persisted. Patient was then started with levetiracetam and topiramate. Patient was discharged with severe sequele after 4 months of hospitalization. However, patient died 2 months after discharged because of delay in seeking medical attention by family while the status epilepticus recurred. Case 2, was a 5-year-old girl with herpes simplex encephalitis. Patient was already treated with phenitoin, phenobarbital, midazolam, tiopenthal, propofol infusion and oral topiramat. On day 18, midazolam and tiopenthal were stopped, but we increased the propofol and topiramat until maximal dose. Finally, the seizure was controlled after 12 days treatment. Patient was discharged with moderate sequele. In monitoring, her developmental condition was improving well.
[Conclusion]
SRSE is a life-threatening neurologic emergency. It requires appropriate treatment to decrease morbidity and mortality.
Super refractory status epilepticus (SRSE) is defined as status epilepticus that continues 24 hours or more after the onset of anaesthesia, including those cases in which the status epilepticus recurs on the reduction or withdrawal of anaesthesia, appropriate therapy of these cases is poorly studied.
[Cases]
Case 1, was a 4-year-old girl with tuberculous meningoencephalitis. Patient was referred because of uncontrolled seizures, phenobarbital injection was already given. In our hospital, patient suffered SRSE and was treated with diazepam, phenytoin and phenobarbital, consecutively, but the seizure remained. Laboratory revealed hypokalemia and hypoalbuminemia. Thus, midazolam was administered for 2 months, combined with propofol. Due to dyslipidemia condition, propofol was substituted with ketamin. After 2 months, SRSE was controlled but occasional seizures still persisted. Patient was then started with levetiracetam and topiramate. Patient was discharged with severe sequele after 4 months of hospitalization. However, patient died 2 months after discharged because of delay in seeking medical attention by family while the status epilepticus recurred. Case 2, was a 5-year-old girl with herpes simplex encephalitis. Patient was already treated with phenitoin, phenobarbital, midazolam, tiopenthal, propofol infusion and oral topiramat. On day 18, midazolam and tiopenthal were stopped, but we increased the propofol and topiramat until maximal dose. Finally, the seizure was controlled after 12 days treatment. Patient was discharged with moderate sequele. In monitoring, her developmental condition was improving well.
[Conclusion]
SRSE is a life-threatening neurologic emergency. It requires appropriate treatment to decrease morbidity and mortality.