Literature review, case report, and expert discussion of prolonged refractory status epilepticus

Neurocrit Care. 2006;4(1):35-46. doi: 10.1385/NCC:4:1:035.

Abstract

We report the case of a 30-year-old woman with severe, prolonged refractory status epilepticus requiring more than 6 months of iatrogenic coma. Opinions on prognosis and clinical management were solicited from a number of experienced neurointensivists and epileptologists at multiple time-points during the clinical course. The ensuing discussion, annotated with references, is presented here. Several experts commented on isolated cases of young patients with encephalitis requiring up to 2-3 months of iatrogenic coma, yet still having good outcomes. Treatments discussed include ketamine, gammaglobulin, plasmapheresis, steroids, adrenocorticotropic hormone, very high-dose phenobarbital, isoflurane, lidocaine, electroconvulsive therapy, ketogenic diet, hypothermia, magnesium, transcranial magnetic stimulation, vagus nerve stimulation, deep brain stimulation, and neurosurgery. The patient eventually suffered a cardiac arrest but was resuscitated as requested by the family. Seizures then stopped, and the patient has remained in a persistent vegetative state since.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Anticonvulsants / therapeutic use
  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain / physiopathology
  • Deep Brain Stimulation
  • Female
  • Humans
  • Persistent Vegetative State / etiology*
  • Prognosis
  • Radiography
  • Status Epilepticus / complications*
  • Status Epilepticus / diagnosis
  • Status Epilepticus / therapy*

Substances

  • Anticonvulsants