Antiepileptics
- PDF / 169,882 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 29 Downloads / 154 Views
1 S
Lack of efficacy: case report A 33-year-old man experienced lack of efficacy following treatment with ketamine, lacosamide, levetiracetam, midazolam and sodium valproate for status epilepticus [not all routes and dosages stated]. The man underwent a procedure for stone removal. Four hours post-extubation, he developed headache, desaturation, unconsciousness and seizures. He was on ventilator in a comatose state. An EEG demonstrated generalised spike wave discharges (GSW). He was treated with IV levetiracetam injection 1.5gm twice a day, IV sodium valproate injection 1gm twice a day and IV lacosamide 200mg injection twice a day. He was also treated with midazolam, which was titrated at a dose of up to 300 mg/hr. However, EEG demonstrated persistent GSW with intermittent clinical seizures. Therefore, the man started receiving ketamine which was titrated at a dose of upto 170 mg/hr. However, his seizures continued. He developed sepsis and hypotension [aetiology not stated]. Hence, ketamine dose was not increased further. Analysis of CSF revealed elevation of protein levels. He received unspecified treatment for sepsis. Thereafter, he received the second cycle of midazolam. However, no response was observed to a higher dose of midazolam. Therefore, he was treated with thiopental sodium. Subsequently, burst suppression was achieved. Anaesthesia recycling was done with 6 cycles of midazolam, 2 cycles of ketamine and 3 cycles of thiopental sodium. On day 15, brain MRI findings indicated sequelae of hypoxic ischaemic injury. Eventually, he was discharged on oral levetiracetam 3 g/day tablet, oral sodium valproate 1000 mg/day tablet and clonazepam. Jadhav A, et al. An unusual survivor of status epilepticus: A case report. Journal of the Neurological Sciences 405 (Suppl.): 127, 15 Oct 2019. Available from: URL: http:// 803446944 doi.org/10.1016/j.jns.2019.10.1009 [abstract]
0114-9954/20/1787-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 18 Jan 2020 No. 1787
Data Loading...
