• Jung-Ick Byun, Kon Chu, Jun-Sang Sunwoo, Jangsup Moon, Tae-Joon Kim, Jung-Ah Lim, Jin-Sun Jun, Han Sang Lee, Woo-Jin Lee, Doo Young Lee, Daejong Jeon, Soon-Tae Lee, Keun-Hwa Jung, Ki-Young Jung, and Sang Kun Lee.
• Seoul National University Hospital,, Program in Neuroscience, Seoul National University College of Medicine, Seoul, South Korea.
• Epileptic Disord. 2015 Dec 1; 17 (4): 444-52.

AimsTo evaluate the efficacy and safety of mega-dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super-refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients.MethodsAdult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events. SRSE outcome was divided into six categories: successful therapy, initial failure, breakthrough seizures, withdrawal seizures, intolerable side effects, and death during treatment.ResultsTen adult patients with SRSE received MDPB. Median age at seizure onset was 38 years (range: 18-59), and half were male. All patients had no history of seizures and had symptoms suggestive of viral encephalitis. Median duration of status epilepticus was 17.5 days (range: 6-60) and anaesthetics were used for a median of 14.0 days (range: 2-54) before MDPB. Successful control of SRSE was achieved in half of the patients, however, only one of ten patients was able to fully recover at discharge. Median duration of the MDPB was 45.5 days and the maximum serum phenobarbital level reached a median of 151.5 μg/ml. Patients with successful MDPB therapy had normal brain imaging (80% vs. 0%; p=0.048) and better functional outcome at discharge and after three months of follow-up. Infection was the most critical complication, along with cardiorespiratory depression.ConclusionMDPB is a therapeutic option for control of SRSE when other choices are exhausted.

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