INTRACTABLE STATUS EPILEPTICUS

Optimal treatment strategies and mortality for prolonged generalized convulsive status epilepticus (SE) remain uncertain. This is especially so in cases in which SE recurs after initial treatment with pentobarbital (''intractable SE''). Two patients exhibited intractable SE for 26 and 56 days. When pentobarbital produced systemic hypotension, a continuous infusion of lorazepam was substituted without hypotension. Both patients survived and recovered adequately to be discharged home. EEG was monitored continuously in both patients. An orderly sequence of electrographic SE stages was seen as SE was terminated or recurred. These findings indicate survival after intractable SE is possible and also suggest lorazepam may be an effective alternative to pentobarbital for treatment of such severe cases.