Very High Dose Phenobarbital for Refractory Status Epilepticus
Somsak Tiamkao MD*, Nattakarn Mayurasakorn MD**, Panit Suko MD**, Suthipun Jitpimolmard MD***, Suwanna Arunpongpaisal MD***, Warinthorn Phuttharak MD***, Narong Auevitchayapat MD***, Suda Vannaprasaht MD***, Siriporn Tiamkao MD***, Kutcharin Phunikhom MD***, Aporanee Chaiyakum MSc***, Jiamjit Saengsuwan MSc***
Affiliation : * Division of Neurology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen ** Department of Medicine, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen *** Srinagarind Epilepsy Research Group, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen
Background : Refractory status epilepticus (RSE), defined as status epilepticus that fails to respond to first,
second and third-line therapy. The RSE is associated with high morbidity and mortality. Treatment guidelines
of RSE give a spectrum of options, such as, continuous intravenous (i.v.) midazolam (MDL), or continuous i.v.
propofol (PRO) as alternatives to phenobarbital (PB) or continuous i.v. pentobarbital (PTB).
Objective : To study the efficacy of very-high-dose phenobarbital (VHDPB) for treatment RSE.
Study
Design : Retrospective study.
Materials and Methods : The authors collected and analyzed data from adult patients who were diagnosed with
RSE.
Results : The authors present 10 patients with RSE who were treated with VHDPB. All of them were generalized
convulsive status epilepticus (GCSE). Ages ranged from 16-86 years old (mean: 43 years). PB dosage ranged
40-140 mg/kg/day (mean: 70 mg/kg/day). The duration of status epilepticus (SE) varied widely, ranged 1-44
days (mean: 7 days). PB level ranged 35.29-218.34 ug/mL (mean 88.1 ug/mL). RSE was controlled by VHDPB
70%, 30% were not controlled.
Conclusion : VHDPB were considered as alternative treatment for RSE.
Keywords : Refractory status epilepticus, Very high dose phenobarbital, Treatment
