Successful treatment of drug-resistant status epilepticus - a case report

The 18-years-old woman was transferred to the Department of Neurology from a psychiatric ward. She had 16-years history of epilepsy with complex partial seizures with secondary generalisation. Cause of epilepsy - unknown. There had been several hospitalisations because of drug resistance and two episodes of status epilepticus partial seizures secondarily generalised. In October 2003 her seizures increased in frequency and were accompanied by behavioural abnormalities. A change of antiepileptic drug (AED) therapy did not improve seizure control. The patient was hospitalised in the neurological and psychiatric wards and was then admitted to the Department of Neurology where she was developed status epilepticus. Neurological examination revealed asymmetry of the tendon reflex l > r. Brain CT scan was normal. The treatment used to resolve status epilepticus included maximum recommended doses of diazepam, clonazepam, valproate solium, phenytoin, phenobarbital, lidocaine, midazolam and 2-days thiopental-inducted coma. The patient was fed through a tube and the formerly used AEDs: TGB, VPA, TPH were continued. Despite this therapy the patient experienced up to 50 seizures daily with an upward rolling of the eyes, blinking, salivation, bradycardia, mouth movements, shoulder jerks and head bend. EEG revealed generalised seizure pathology and CSF analysis showed increased protein levels. Administration of propofol intravenously and levetiracetam through the tube resulted in seizure termination within an hour and improved EEG recording. The propofol therapy caused decreases in arterial blood pressure, witch required a 4-day administration of presser amines. On treatment day 14, the patient was extubated. Her neurological status was good, with no intellectual regression. The patient remained seizure - free for 4 weeks.