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Multicenter Study
. 2021 Dec;35(3):631-639.
doi: 10.1007/s12028-021-01250-z. Epub 2021 Jul 20.

Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

Henning R Stetefeld  1 , Alexander Schaal  1 , Franziska Scheibe  2   3 , Julia Nichtweiß  2 , Felix Lehmann  4 , Marcus Müller  5 , Stefan T Gerner  6 , Hagen B Huttner  6 , Sebastian Luger  7 , Hannah Fuhrer  8 , Julian Bösel  9   10 , Silvia Schönenberger  9 , Konstantinos Dimitriadis  11 , Bernhard Neumann  12 , Kornelius Fuchs  12 , Gereon R Fink  1   13 , Michael P Malter  14 ; IGNITE Study Group, with support from the German Neurocritical Care Society (DGNI)
Affiliations
Multicenter Study

Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

Henning R Stetefeld et al. Neurocrit Care. 2021 Dec.

Abstract

Background: We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs).

Methods: This was a multicenter retrospective study of patients with RSE/SRSE treated with isoflurane for status epilepticus termination admitted to the neuro-ICUs of nine German university centers during 2011-2018.

Results: We identified 45 patients who received isoflurane for the treatment of RSE/SRSE. During isoflurane treatment, electroencephalograms showed no epileptiform discharges in 33 of 41 (80%) patients, and burst suppression pattern was achieved in 29 of 41 patients (71%). RSE/SRSE was finally terminated after treatment with isoflurane in 23 of 45 patients (51%) for the entire group and in 13 of 45 patients (29%) without additional therapy. Lengths of stay in the hospital and in the neuro-ICU were significantly extended in cases of ongoing status epilepticus under isoflurane treatment (p = 0.01 for length of stay in the hospital, p = 0.049 for length in the neuro-ICU). During isoflurane treatment, side effects were reported in 40 of 45 patients (89%) and mainly included hypotension (n = 40, 89%) and/or infection (n = 20, 44%). Whether side effects occurred did not affect the outcome at discharge. Of 22 patients with follow-up magnetic resonance imaging, 2 patients (9%) showed progressive magnetic resonance imaging alterations that were considered to be potentially associated with RSE/SRSE itself or with isoflurane therapy.

Conclusions: Isoflurane was associated with a good effect in stopping RSE/SRSE. Nevertheless, establishing remission remained difficult. Side effects were common but without effect on the outcome at discharge.

Keywords: Epilepsy; Isoflurane; Status epilepticus.

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Conflict of interest statement

JB has received honoraria for lectures and travel support from Boehringer Ingelheim, Medtronic, Zoll, Bard, and Sedana and has participated in a research award from the Patient-Centered Outcomes Research Institute for the Stroke-Related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical Care Trial 2. GRF has received honoraria for lectures from Bayer, Boehringer Ingelheim, Sanofi, Desitin, GlaxoSmith-Kline, Lilly, and Teva. MPM has received honoraria for consultancy and lectures from UCB and Eisai. FL has received honoraria for lectures from Bayer, Orion Pharma, and Sedana. The remaining authors declare no conflicts of interest.

Comment in

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