High dose of thiopental therapy for refractory status epilepticus in children

초록

HIGH-DOSE OF THIOPENTAL THERAPY FOR REFRACTORY STATUS EPILEPTICUS IN CHILDREN Young Se kwon1, Dong Hyun Kim1 , Kang Ho Cho2, 1Department of Pediatrics, College of Medicine, Inha University, 2Gachon Medical School, Incheon, Korea Objective: Pentobarbital, thiopental, midazolam, IV valproate, and propofol have been used in threatment of refractory status epilepticus (RSE). Among the methods of treatment, pentobarbital coma is most universally accepted, but thiopental or pentobarbital therapy protocol such as duration of treatment or drug dosage has not been established. This study was to evaluate the efficacy of high-dose thiopental therapy for RSE in children. Methods: Four patients admitted to ICU in two hospital met the criteria of RSE from2005 to 2007. All patients had received intravenous admission of phenobarbital, phenytoin, midazolam, and valproate/topiramate before thiopental therapy. A bolus of 5mg/kg thiopental was initial admission, followed by continuous infusion at a rate of 0.5-1.0mg/kg/hr upward to 32mg/kg/hr until their seizures were controlled. They were monitored by portable electroencephalograms and received mechanical ventilation and vassopressor therapy. Results: The subjects are four cases of RSE from age of 5months to 8years, two males and two females. All of four cases showed electrical partial seizure. The mean duration of status epilepticus before thiopental therapy was 72.75±81.2 hr (range 10-191hr) and complete suppression pattern appeared with the maximum dosage 20.5±10.6 mg/kg/hr (range 9-32mg/kg/hr). Duration of total thiopental therapy was 45.8±4.2 hr (range 44-50hr). But 3 patients died during the tapering of thiopental. One patient who was safely tapered, returned to her usual state. But she also died of pneumonia after 2months. Conclusion: High-dose of thiopental therapy can be considered as a therapeutic approach to control refractory status epilepticus.