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Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation.

Henning R Stetefeld1, Alexander Schaal1, Franziska Scheibe2,3

  • 1Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.

Neurocritical Care
|July 21, 2021
PubMed
Summary

Isoflurane effectively stopped refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in 51% of patients. Common side effects like hypotension occurred but did not impact patient outcomes.

Keywords:
EpilepsyIsofluraneStatus epilepticus

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Area of Science:

  • Neuroscience
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are severe neurological emergencies requiring intensive treatment.
  • Isoflurane is used in neurointensive care units (neuro-ICUs) to manage these conditions, but its efficacy and side effect profile require further investigation.

Purpose of the Study:

  • To evaluate the effectiveness of isoflurane in terminating RSE and SRSE.
  • To assess the association between isoflurane treatment and its side effects in neuro-ICU patients.
  • To determine the impact of isoflurane-related side effects on patient outcomes.

Main Methods:

  • A multicenter retrospective study was conducted involving 45 patients with RSE/SRSE treated with isoflurane across nine German university centers (2011-2018).
  • Data on seizure termination, electroencephalogram (EEG) patterns, side effects, and clinical outcomes were collected and analyzed.

Main Results:

  • Isoflurane treatment led to seizure termination in 51% of patients (23/45), with 29% achieving termination without additional therapies.
  • EEG monitoring showed no epileptiform discharges in 80% and burst suppression in 71% of patients.
  • Side effects, primarily hypotension (89%) and infection (44%), were frequent but did not influence discharge outcomes. Extended hospital and neuro-ICU stays were noted in cases with ongoing seizures.

Conclusions:

  • Isoflurane demonstrates a good effect in halting RSE/SRSE, though achieving sustained remission remains challenging.
  • Common side effects associated with isoflurane therapy do not appear to negatively affect patient outcomes at discharge.
  • Further research may be needed to explore long-term effects and optimize isoflurane use in RSE/SRSE management.