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Prolonged high-dose isoflurane for refractory status epilepticus: is it safe?
Jennifer E Fugate1, Joseph D Burns, Eelco F M Wijdicks
1Department of Neurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA.
Anesthesia and Analgesia
|September 16, 2010
Summary
High-dose isoflurane for refractory status epilepticus may cause neurotoxicity. Two patients showed brain MRI abnormalities, including thalamic and cerebellar T2 signal hyperintensity, which resolved after stopping isoflurane.
Area of Science:
- Neuroscience
- Anesthesiology
- Radiology
Background:
- Refractory status epilepticus (RSE) treatment options are limited.
- Isoflurane is an anesthetic agent sometimes used for RSE.
- Human toxicities of isoflurane, particularly with prolonged use, are not well-documented.
Observation:
- Two patients with RSE received prolonged high-concentration isoflurane treatment.
- Patient 1 received isoflurane for 85 days (1975.2% concentration-hours).
- Patient 2 received isoflurane for 34 days (1382.4% concentration-hours).
Findings:
- Both patients developed progressive T2 signal hyperintensities on serial brain MRI.
- Affected brain regions included the thalamus and cerebellum.
- These MRI abnormalities improved after isoflurane discontinuation.
Implications:
- Prolonged, high-dose isoflurane use may be associated with neurotoxicity.
- Isoflurane's potential neurotoxic effects warrant further investigation.
- This finding is critical for managing patients with refractory status epilepticus.
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