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From the Neurology Division, Childrens Hospital of Los Angeles, and the University of Southern California School of Medicine, Los Angeles, CA.
Status epilepticus refractory to initial anticonvulsant therapy is a serious condition with a high morbidity and mortality. We present 50 cases with refractory status epilepticus (RSE) treated with very-high-dose phenobarbital (VHDPB) without reference to a predetermined maximum level or dose. Maximum serum levels ranged from 70 to 344 µg/ml (median, 114 µg/ml). VHDPB controlled seizures in all cases where no limits were imposed upon maximum dose (47/50). We found no maximum dose beyond which further doses are likely to be ineffective. Forty patients were intubated prior to VHDPB, but recovered respiratory drive and could be removed from the ventilator despite very high serum levels. This is explained by acute drug tolerance. Hypotension was unusual, related to the highest levels, and easily controlled. VHDPB has many relative advantages over other therapies presently used for RSE.
Address correspondence and reprint requests to Dr. Mitchell, Neurology Division, Childrens Hospital of Los Angeles, P.O. Box 54700, Los Angeles, CA 90054–0700.
Received July 13, 1987. Accepted for publication in final form November 17, 1987.
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