Isoflurane for 7 days in refractory status epilepticus.

Area of Science:

• Anesthesiology
• Neurology
• Toxicology

Background:

• Status epilepticus (SE) is a neurological emergency requiring prompt treatment.
• Prolonged SE can be refractory to standard therapies, necessitating alternative approaches.
• Limited data exists on the efficacy and safety of continuous isoflurane anesthesia for extended SE management.

Purpose of the Study:

• To present a case of prolonged SE managed with continuous isoflurane anesthesia.
• To evaluate the effectiveness and safety of isoflurane in a refractory SE scenario.
• To highlight isoflurane as a potential therapeutic option for severe SE.

Main Methods:

• A patient with prolonged SE, suspected secondary to thallium intoxication, was treated with continuous isoflurane anesthesia.
• Isoflurane administration was maintained for seven days.
• Seizure activity, adverse effects, and response to treatment were monitored.

Main Results:

• Continuous isoflurane anesthesia successfully suppressed seizure activity for seven days without reported adverse effects.
• Recurrence of seizures was observed upon discontinuation of isoflurane, despite high-dose barbiturate therapy.
• The patient's condition ultimately deteriorated, leading to death several months later.

Conclusions:

• Continuous isoflurane anesthesia can be an effective treatment for prolonged convulsive SE resistant to conventional therapies.
• This anesthetic approach requires expertise in anesthesiology and specialized equipment for safe, prolonged administration.
• Early consideration of isoflurane may be warranted in refractory SE cases, particularly those with toxicological etiologies.