Propofol is a safe and effective drug to treat children with refractory status epilepticus

Propofol is a safe and effective drug to treat children with refractory status epilepticus, and it is recommended before thiopental, according to a study in the August 23, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology. Propofol and thiopental are widely used intravenous anesthetics which are also known to help control seizures.

Researchers in the Netherlands examined the effects of propofol and thiopental in 33 children (34 episodes total) with refractory status epilepticus. Refractory status epilepticus is a state in which seizures occur in rapid succession without recovery of consciousness between them. These seizures are resistant to treatment and persist for more than 60 minutes.

Propofol effectively controlled seizures in 14 out of 22 patients. Side effects from propofol were infrequent and minor. Propofol was given at rates lower than 5 mg/kg/h, due to previous reports about potentially fatal side effects when the delivery rate was greater than 5 mg/kg/h. Two patients successfully treated with propofol died, but their deaths were attributed to severe neurological damage after bacterial meningitis.

Twenty patients were treated with thiopental, including the eight in whom propofol was used first without success. Eleven were effectively treated and had seizure control. There were serious side effects during thiopental treatment. Most patients required higher ventilator settings and supplemental oxygen due to suspected pneumonia. The respiratory problems with thiopental treatment were greater than expected, according to the researchers. Eight of the 20 patients died. Two deaths could be attributed to thiopental, but the others were related to the underlying diseases that had caused the refractory seizures.

The average duration of propofol treatment was about 2.4 days, compared to 8.6 days for thiopental treatment.

"We suggest the use of propofol before thiopental in children with refractory status epilepticus," said study author J. P. J. van Gestel, MD, of the University Medical Center Utrecht, Wilhelmina Children's Hospital, in the Netherlands. "Propofol is a fast-acting drug, and little time is lost if it fails to control seizures."

A related editorial in the same issue of Neurology says this study underscores the need for a systematic, prospective study in children and adolescents with this disorder.

"The study by van Gestel et al is retrospective, sequential, and historical in design which prevents definitive conclusions regarding effectiveness," said editorial author Nina F. Schor, MD, PhD, a pediatric neurologist at Children's Hospital of Pittsburgh. "Given the devastating nature of refractory status epilepticus, the search for newer and better treatments to control this condition safely and quickly is critically important."