We report our experience using
barbiturate anesthesia for the treatment of refractory
status epilepticus. Following a retrospective review of eight patients treated with a variety of
barbiturates and dosing regimens, we established a specific protocol employing
pentobarbital and evaluated it prospectively in six patients. Among the 14 patients, intravenous
barbiturates, when administered with a loading dose followed by continuous infusion, were uniformly effective in aborting
seizures and producing a burst-suppression EEG pattern. Other than the pupillary light reflex, most patients lost all brainstem reflexes and motor responses during
therapy.
Barbiturate-
induced hypotension was observed in 9 of the 14 patients, and required treatment with pressors in seven cases. Three patients died early as a consequence of their underlying illness, while three others died late for reasons unrelated to the status itself or to
anticonvulsant therapy. The time to recovery of function following
anesthesia varied highly, spanning hours to days for return of motor function and days to weeks for cognition. Of the eight survivors, four were left with mild cognitive deficits, one returned to his baseline
dementia, and three had residual
encephalopathies (severe in two). We conclude that
barbiturate anesthesia is an extremely effective
therapy for refractory
seizures. However, its use necessitates recognition of untoward cardiovascular responses and prolonged
intensive care.