Parenteral phenobarbital in status epilepticus revisited: Mayo Clinic experience

Epilepsia
Sara HockerJeffrey Britton

Abstract

Despite phenobarbital (PB) being a key component in status epilepticus (SE) treatment algorithms for decades, it has fallen out of favor compared to newer nonsedating medications due to potential for respiratory suppression and prolonged sedation. We retrospectively analyzed all nonintubated patients with refractory SE treated with parenteral PB. Forty patients were identified as having received PB in the neurologic intensive care unit at Mayo Clinic over a 7-year period through our pharmacy dispensing database. Patients who received PB for maintenance therapy, those replenishing subtherapeutic levels, those who were already intubated, and those receiving PB for a non-SE indication were excluded. Clinical data, prior treatments, therapeutic response, and outcome were reviewed. Eight patients were identified. Ages ranged from 24 to 77 years (median = 64 years); all had focal SE, and none was comatose. Seizure activity improved acutely following PB administration in seven and stopped in six. Dosages ranged from 5 to 19.8 mg/kg (median = 10.1 mg/kg); none required intubation, and one received supplemental oxygen. Patients received a median of four antiepileptic drugs prior to PB. Median interval between first drug and PB was 23.5 ...Continue Reading

References

Apr 2, 1998·The New England Journal of Medicine·D H Lowenstein, B K Alldredge
Feb 15, 2002·Archives of Neurology·Stephan A MayerBrian-Fred Fitzsimmons
Jul 10, 2007·Seizure : the Journal of the British Epilepsy Association·Puneet AgarwalNiren Garg
Feb 14, 2012·European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society·Reza Azizi MalamiriMahmoud Reza Ashrafi
Apr 25, 2012·Neurocritical Care·Gretchen M BrophyUNKNOWN Neurocritical Care Society Status Epilepticus Guideline Writing Committee
Jan 16, 2013·JAMA Neurology·Sara E HockerAlejandro A Rabinstein
Feb 6, 2015·Critical Care Medicine·Nicola A MarchiAndrea O Rossetti

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Citations

Aug 30, 2019·Medizinische Klinik, Intensivmedizin und Notfallmedizin·Frank Erbguth
Sep 6, 2020·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Petra Opić, Raoul Sutter
Dec 11, 2020·Expert Review of Neurotherapeutics·Giovanni MastroianniEdoardo Ferlazzo
Nov 7, 2020·Seminars in Neurology·Rana Moosavi, Christa B Swisher
Mar 6, 2021·Current Opinion in Neurology·Andrea O Rossetti, Vincent Alvarez
Mar 30, 2021·Brain : a Journal of Neurology·Aidan NeliganMatthew C Walker

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