Endosulfan-Induced Prolonged Super-Refractory Status Epilepticus

Endosulfan is a highly toxic pesticide that causes hyperstimulation of the central nervous system by antagonizing gamma aminobutyric acid-mediated inhibition. Seizure is the most important manifestation of endosulfan poisoning, frequently progressing to status epilepticus and refractory status epilepticus. Here, we report a recent case of a 64-year-old man with endosulfan-induced super-refractory status epilepticus, which persisted for a remarkably longer period than has been described in previous reports. The patient arrived at the emergency room with continuous generalized tonic-clonic seizures. Electroencephalogram-recorded seizures that persisted even after intravenous administration of lorazepam and antiepileptic drugs. Intravenous anesthetic agents were administered for 9 days to confront the persistently recurring seizures. Immediately after this treatment period, the seizures subsided, and the patient showed marked neurological improvement. After 2 months however, he died of multiple systemic complications. This case report elucidates the importance of aggressive evaluation and management including continuous EEG monitoring in cases of endosulfan-related status epilepticus.