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Treatment of convulsive status epilepticus with propofol: case report
A M Harrison1, R A Lugo, J E Schunk
1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
Insights
Propofol effectively controlled refractory convulsive status epilepticus (CSE) in a pediatric patient. This case highlights propofol as a potential treatment for severe CSE when other options fail, emphasizing the need for intensive monitoring.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Emergency Medicine
Background:
- Refractory convulsive status epilepticus (CSE) poses a significant challenge in pediatric emergency and critical care.
- Prompt seizure termination is crucial to prevent adverse neurological outcomes and mortality.
Observation:
- A nine-month-old infant with hereditary fructose intolerance experienced prolonged, refractory CSE.
- Seizures were effectively controlled with propofol (3 mg/kg bolus followed by 100 mcg/kg/min infusion).
- This therapeutic dose achieved electroencephalographic burst suppression.
Findings:
- This case represents the first reported pediatric use of propofol for prolonged, refractory CSE.
- The patient required endotracheal intubation, invasive hemodynamic monitoring, and pressor support.
- Adult data on propofol for refractory status epilepticus was reviewed.
Implications:
- Propofol is a viable treatment option for refractory CSE in children.
- Its administration necessitates a setting with advanced life support capabilities, including airway management and hemodynamic monitoring.
- This case highlights the importance of considering novel therapeutic agents in challenging pediatric neurological emergencies.
Introduction:
Convulsive status epilepticus (CSE) refractory to treatment with benzodiazepines, phenobarbital, and phenytoin presents a challenge to pediatric emergency and critical care specialists. Prompt seizure control may prevent mortality and morbidity.
Case:
A nine-month-old girl with hereditary fructose intolerance had prolonged, refractory CSE. Her seizures promptly stopped after administration of propofol (3 mg/kg bolus followed by infusion of 100 micrograms/kg/min). This dose resulted in electroencephalographic burst suppression. She required endotracheal intubation, invasive hemodynamic monitoring, and pressor support.
Discussion:
This is the first pediatric case of prolonged, refractory CSE treated with propofol. The adult experience is reviewed. Propofol should be used only in a setting where definitive airway control and hemodynamic support is possible.