Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain
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ORIGINAL ARTICLE
Phenytoin, Levetiracetam, and Pregabalin in the Acute Management of Refractory Status Epilepticus in Patients with Brain Tumors Christa B. Swisher • Meghana Doreswamy • Krista J. Gingrich • James J. Vredenburgh • Brad J. Kolls
Published online: 1 September 2011 Ó Springer Science+Business Media, LLC 2011
Abstract Background There were nearly 700,000 patients in the United States in 2010 living with brain tumor diagnoses. The incidence of seizures in this population is as high as 70% and is historically difficult to control. Approximately 30–40% of brain tumors patients who present with status epilepticus (SE) will not respond to typical therapy consisting of benzodiazepines and phenytoin (PHT), resulting in patients with refractory status epilepticus (RSE). RSE is usually treated with anesthetic doses of propofol or midazolam infusions. This therapy can have significant risk, particularly in patients with cancer. Methods A retrospective chart review was performed on 23 patients with primary or metastatic brain tumors whose SE was treated with intravenous PHT, levetiracetam (LEV), and oral pregabalin (PGB). Results In all the patients under study, PHT or LEV was used as first-line therapy. PGB was typically used as thirdline treatment. The median daily dose of PGB was 375 mg (usually divided BID or TID), and the median daily dose of LEV 3000 mg (usually divided BID). Cessation of SE was seen in 16/23 (70%) after administration of PHT, LEV, and PGB. SE was aborted, on average, 24 h after addition of the third antiepileptic drug. Only one patient in the responder group required intubation. Mortality rate was zero in the responder group. No adverse reactions to this medication regimen were observed.
C. B. Swisher M. Doreswamy K. J. Gingrich J. J. Vredenburgh B. J. Kolls (&) Division of Neurology, Department of Medicine, Duke University Medical Center (DUMC), Box 2900, Durham, NC 27710, USA e-mail: [email protected]
Conclusion Our study suggests that the administration of PHT, LEV, and PGB in brain tumor patients with RSE is safe and highly effective. Keywords Refractory status epilepticus Status epilepticus Brain tumor Phenytoin Levetiracetam Pregabalin
Background and Significance In the United States in 2010, there was an estimated population of 6,88,096 individuals living with primary brain tumor diagnoses, and the prevalence rate for these tumors was estimated to be 221.8 per 1,00,000 [1] Seizures in patients with primary and metastatic brain tumors occur commonly. Previous studies have shown that the incidence of seizures in patients with brain tumors is 30–70% [2, 3]. Seizures are notoriously difficult to control in the brain tumor population. Hildebrand et al. [4] found that over half of brain tumor patients continued to have seizures despite treatment with AEDs. In a study by Moots et al. [5] 26% of patients with brain tumors and epilepsy developed status epilepticus (SE). Furthermore, up to 20% of adult patients with SE have brain tumors as the cause of SE [6–11]. The o
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