Abstracts

Refractory status epilepticus (RSE) is associated with a high mortality and high incidence of neurological sequelae. Long term follow up (up to one year) of three patients treated with prolonged iatrogenic coma for RSE is reported. Three female patients ages 17, 29 and 33 years were admitted to the ICU in status epilepticus refractory to standard treatment. Two were new onset seizures secondary to viral encephalitis and the third was an exacerbation of seizure activity secondary to a mitochondrial disorder. Prolonged iatrogenic coma was induced for up to 54, 59 and 81 days respectively. All three required high doses of antiepileptic medications, in polypharmacy to control seizure activity. VNS was implanted in one case to control seizures
Upon hospital discharge, all of the patients were followed by an epileptologist.
Medications were reviewed and adjusted when necessary, seizure count was recorded, evaluation of activities of daily living (ADL) was noted and neurological exam was performed. All three patients have improved seizure control on polypharmacy.
One patient experienced breakthrough seizures secondary to missed doses of AED. She is now seizure free on dual drug therapy. Neurologically, she demonstrates only a mild monoparesis of a lower extremity.
The patient with a mitochondrial disorder has rare simple partial hemifacial seizures.
She has demonstrated significant gain in ADL, ambulation, and speech ,all of which show improvement over her pre RSE condition.
The third patient with concomitant diagnosis of schizophrenia experienced breakthrough seizures when ,at another facility, reduction of AEDs was undertaken. Currently, adjustments have been made with significant improvement in seizure control. Fluctuations in cognitive skills are seen, which may be related to her psychiatric condition. She does not however, demonstrate any focal neurological deficits. The management of RSE remains a challenge. Each of the patients required prolonged iatrogenic coma. Each responded to different agents and to polypharmacy. Long term outcome has been favorable in each case. Despite the perception that RSE carries a poor prognosis, close supervision and aggressive treatment can result in a favorable outcome