Abstracts

Rationale: Thiopental is an ultra short-acting barbiturate that can be used to treat refractory status epilepticus (RSE). The published literature on dosing, safety and efficacy for treatment of RSE in children is limited. Methods: Retrospective single centre review of children treated with thiopental infusion for RSE between 2004-2009. We collected data on the etiology and type of RSE, antiepileptic drugs used, dosage and duration of thiopental infusion, thiopental-related side effects and efficacy at aborting seizures, and outcome at hospital discharge. Results: We identified 11 children aged 2 months to 17 years who received thiopental infusions for RSE. All patients were admitted to the ICU, intubated and monitored by continuous EEG. Patients had received between 4 and 7 other anti-epileptic drugs prior to thiopental use. The mean thiopental infusion rate required to achieve EEG burst-suppression or seizure cessation was 4.7 mg/kg/hr (range: 2-8 mg/kg/hr). Short-term seizure cessation was achieved in 8/11 patients, with no clear correlation between efficacy and dosing. The mean duration of thiopental treatment was 69 hrs (range: 40-120 hrs). The mean cumulative thiopental dose was 291 mg/kg (range: 91-526 mg/kg). No life-threatening side effects occurred during treatment, however 10/11 patients required inotropic support and 6/11 developed pneumonia during or shortly following thiopental therapy. Outcome at hospital discharge was variable, ranging from return to baseline function to death following withdrawal of life sustaining therapy. Conclusions: At the doses above, thiopental infusion achieved short-term seizure cessation in the majority of children, although virtually all children developed hypotension requiring inotropic support, and half developed pneumonia. These findings support the cautious use of thiopental for the treatment of RSE in children.