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Neurocritical Care

, Volume 14, Issue 1, pp 4–10 | Cite as

A Randomized Trial for the Treatment of Refractory Status Epilepticus

  • Andrea O. Rossetti
  • Tracey A. Milligan
  • Serge Vulliémoz
  • Costas Michaelides
  • Manuel Bertschi
  • Jong Woo Lee
Original Article

Abstract

Background

Refractory status epilepticus (RSE) has a mortality of 16–39%; coma induction is advocated for its management, but no comparative study has been performed. We aimed to assess the effectiveness (RSE control, adverse events) of the first course of propofol versus barbiturates in the treatment of RSE.

Methods

In this randomized, single blind, multi-center trial studying adults with RSE not due to cerebral anoxia, medications were titrated toward EEG burst-suppression for 36–48 h and then progressively weaned. The primary endpoint was the proportion of patients with RSE controlled after a first course of study medication; secondary endpoints included tolerability measures.

Results

The trial was terminated after 3 years, with only 24 patients recruited of the 150 needed; 14 subjects received propofol, 9 barbiturates. The primary endpoint was reached in 43% in the propofol versus 22% in the barbiturates arm (P = 0.40). Mortality (43 vs. 34%; P = 1.00) and return to baseline clinical conditions at 3 months (36 vs. 44%; P = 1.00) were similar. While infections and arterial hypotension did not differ between groups, barbiturate use was associated with a significantly longer mechanical ventilation (P = 0.03). A non-fatal propofol infusion syndrome was detected in one patient, while one subject died of bowel ischemia after barbiturates.

Discussion

Although undersampled, this trial shows significantly longer mechanical ventilation with barbiturates and the occurrence of severe treatment-related complications in both arms. We describe practical issues necessary for the success of future studies needed to improve the current unsatisfactory state of evidence.

Keywords

Propofol Thiopental Pentobarbital Burst-suppression Outcome Complications 

Notes

Acknowledgments

The study was supported in part by grants from the Swiss League against Epilepsy, AstraZeneca (Switzerland) and UCB (Switzerland). The six authors do not have any other financial disclosures or conflict of interest. The authors wish to thank Dr Jan Novy (CHUV Lausanne), Katherine Gleason, and Sonia Replansky (BWH Boston, MA) for their help in data acquisition, and Dr Nathan B. Fountain (Charlottesville, VA) for his inputs on the study design. We confirm that we have read the Journal’s position on issues involved in ethical publications and affirm that this report is consistent with those guidelines.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Andrea O. Rossetti
    • 1
  • Tracey A. Milligan
    • 2
  • Serge Vulliémoz
    • 3
  • Costas Michaelides
    • 4
  • Manuel Bertschi
    • 5
  • Jong Woo Lee
    • 2
  1. 1.Department of NeurologyCHUV et Université de Lausanne, CHUV-BH07LausanneSwitzerland
  2. 2.Department of NeurologyBrigham and Women’s Hospital, Harvard School of MedicineBostonUSA
  3. 3.Department of NeurologyHUGGenevaSwitzerland
  4. 4.Department of NeurologyMassachusetts General Hospital, Harvard School of MedicineBostonUSA
  5. 5.Department of NeurologyInselspitalBerneSwitzerland

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