Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus

2018 ◽  
Vol 32 (2) ◽  
pp. 228-230 ◽  
Author(s):  
Robert H. Witcher ◽  
Michelle M. Ramirez
Keyword(s):  
Drug Reaction ◽  
Status Epilepticus ◽  
Signs And Symptoms ◽  
Punch Biopsy ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status ◽  
Life Threatening ◽  
Antiepileptic Medications ◽  
Systemic Symptoms

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. Summary: A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. Conclusions: Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.

scholarly journals Ultra-short burst suppression as a “reset switch” for refractory status epilepticus

Seizure ◽  
2019 ◽  
Vol 64 ◽  
pp. 41-44 ◽  
Author(s):  
Alvin S. Das ◽  
Jong Woo Lee ◽  
Saef Izzy ◽  
Henrikas Vaitkevicius
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Short Burst ◽  
Refractory Status

scholarly journals Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

2021 ◽  
Vol 2 (4) ◽  
pp. 3
Author(s):  
Sanum Kashif
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
High Grade Fever ◽  
Refractory Status ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Permanent Brain Damage

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

Propylene Glycol-Induced Lactic Acidosis in a Patient Receiving Continuous Infusion Pentobarbital

2008 ◽  
Vol 42 (10) ◽  
pp. 1502-1506 ◽  
Author(s):  
Melissa A Miller ◽  
Allison Forni ◽  
Dinesh Yogaratnam
Keyword(s):  
Status Epilepticus ◽  
Continuous Infusion ◽  
Propylene Glycol ◽  
Elevated Serum ◽  
Signs And Symptoms ◽  
Refractory Status Epilepticus ◽  
Serum Lactate ◽  
Burst Suppression ◽  
Maintenance Infusion ◽  
Osmolal Gap

Objective: To report a case of probable propylene glycol (PG) toxicity in a patient receiving continuous infusion of pentobarbital for refractory status epilepticus. Case Summary: A 59-yoar-old woman with a declining mental status was admitted to the intensive care unit for management of status epilepticus. After failing to achieve the therapeutic endpoint of electroencephalogram burst suppression with a continuous infusion of propofol, the sedative regimen was changed to continuous infusion of pentobarbital. The patient received a loading dose of 450 mg (5 mg/kg), and the maintenance infusion was titrated to a dose of 10 mg/kg/h to achieve burst suppression. Twelve hours after the pentobarbital infusion was started, the patient developed an anion gap metabolic acidosis, elevated serum lactate level, hyperosmolality, and increased osmolal gap. The pentobarbital infusion was discontinued, and the patient's acidosis and hyperosmolality resolved. Discussion: Pentobarbital contains 40% v/v of PG, which was thought to be a potential source of the patient's metabolic derangements. Reports of toxicity with drugs containing PG. particularly intravenous lorazepam, have been well described in the literature. What we describe, however, is one of few reports involving intravenous pentobarbital. The Naranjo probability scale supports a probable drug-related adverse event in our patient. Conclusions: PG toxicity is a potential complication associated with intravenouspentobarbital. Practitioners should be aware of the PG content of pentobarbital and should be familiar with the signs and symptoms associated with PG toxicity.

scholarly journals Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus

2021 ◽  
Author(s):  
Joseph Peedicail ◽  
Neil Mehdiratta ◽  
Shenghua Zhu ◽  
Paulina Nedjadrasul ◽  
Marcus C. Ng
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status

scholarly journals Management of Status Epilepticus

2019 ◽  
Vol 06 (03) ◽  
pp. 267-274
Author(s):  
Ritesh Lamsal ◽  
Navindra R. Bista
Keyword(s):  
Status Epilepticus ◽  
High Risk ◽  
Critically Ill Patients ◽  
Initial Treatment ◽  
Refractory Status Epilepticus ◽  
The Past ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
Life Threatening ◽  
High Doses

AbstractStatus epilepticus (SE) is a life-threatening neurologic condition that requires immediate assessment and intervention. Over the past few decades, the duration of seizure required to define status epilepticus has shortened, reflecting the need to start therapy without the slightest delay. The focus of this review is on the management of convulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment of both forms of status epilepticus includes immediate assessment and stabilization, and administration of rapidly acting benzodiazepine therapy followed by nonbenzodiazepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and SRSE) pose a lot of therapeutic problems, necessitating the administration of continuous infusion of high doses of anesthetic agents, and carry a high risk of debilitating morbidity as well as mortality.

Therapeutic burst-suppression coma in pediatric febrile refractory status epilepticus

2017 ◽  
Vol 39 (8) ◽  
pp. 693-702 ◽  
Author(s):  
Jainn-Jim Lin ◽  
Cheng-Che Chou ◽  
Shih-Yun Lan ◽  
Hsiang-Ju Hsiao ◽  
Yu Wang ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status

scholarly journals P.019 A machine learning approach to asymmetric burst suppression and refractory status epilepticus outcome

2021 ◽  
Vol 48 (s3) ◽  
pp. S25-S25
Author(s):  
G Farhani ◽  
N Farhani ◽  
MC Ng
Keyword(s):  
Machine Learning ◽  
Status Epilepticus ◽  
Left Hemisphere ◽  
Learning Algorithm ◽  
Principal Component ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status ◽  
The Right ◽  
Component Feature

Background: Treatment of refractory status epilepticus (RSE) is often titrated to achieve EEG burst suppression. However, optimal burst suppression characteristics are largely unknown. We used an unsupervised machine learning algorithm to predict RSE outcome based on the quantitative burst suppression ratio (QBSR). Methods: We conducted principal component analysis (PCA) as a linear combination of 22 QBSR features from non-anoxic adult RSE patients at the Winnipeg Health Sciences Centre. We also determined the most predictive components that significantly differed between survivors and non-survivors. Results: Using 135,765 QBSRs from 7 survivors and 10 non-survivors, PCA identified a predominantly non-survivor cluster of 8 patients (75% non-survivors). The first 2 PCA components comprised 75% data variance. The most important first component feature was skewness of QBSR distribution in the right or left hemisphere (0.52 each). The most important second component feature was third QBSR quantile of the left hemisphere (0.49). Only right hemispheric QBSR features significantly differed between groups: QBSR skewness for the first component (Benjamini-Hochberg adjusted p=0.038) and average QBSR for the second component (0.32, Benjamini-Hochberg adjusted p=0.046). Conclusions: Our pilot study shows that RSE patient survival may be impacted by QBSR, with differential hemispheric EEG burst suppression characteristics predicting poor RSE outcome.

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