Status epilepticus (SE), a dangerous condition in which epileptic seizures follow one another for a duration of five or more minutes without the victim’s regaining consciousness between them, is the second most common neurological emergency in the United States, with a recorded maximum of around 150,000-plus cases per year. In 60-70 percent of cases, the patient responds to antiepileptic medications and benzodiazepines.
But a combination of those medications doesn’t always work, says Wolfgang Muhlhofer, M.D., an assistant professor of neurology in the University of Alabama at Birmingham Epilepsy Center. Up to 44 percent of status epilepticus cases progress to refractory status epilepticus (RSE), where the patient doesn’t respond to those drugs, and more extreme treatments have to be used.
“These emergencies require prompt and effective treatment,” Muhlhofer said. “The longer SE is going on, the higher the chances of brain damage or the body’s being unable to compensate for the trauma, leading to other complications like cardiac arrest or kidney or heart failure. There’s a lot of risk associated with this condition.”
Muhlhofer wanted to analyze RSE patients in a more systematic way, with the hopes of determining more specific guidelines regarding the lengths of what he calls “therapeutic coma.” He designed a study of adult patients, admitted to UAB or University of California, San Francisco Medical Center during a seven-year period, who were placed in an artificial coma and who had a seizure recurrence within the first 48 hours of lightening the patient’s sedative medications.
While artificial coma is the agreed-upon treatment for RSE patients, Muhlhofer says there isn’t an evidence-based consensus on how long patients should be kept in this state, and recent studies of this patient population have shown that, the longer a patient is kept in an artificial coma, the more likely they are to have complications during their hospitalizations or, worse, permanent problems with physical and cognitive functions.