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Propofol for resistant status epilepticus
  1. Simon Carley, Specialist Registrar,
  2. Ian Crawford, Research Fellow
  1. K Mackway-Jones, Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK;
  1. kevin.mackway-jones{at}man.ac.uk

Abstract

A short cut review was carried out to establish whether propofol is effective at stopping fitting in resistant status epilepticus. Altogether 24 papers were found using thereported search, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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Report by Simon Carley,Specialist Registrar
 Checked by Ian Crawford, Research Fellow

Clinical scenario

A 20 year old man presents to the emergency department in status epilepticus. Initial treatment with benzodiazepines and phenytoin is unsuccessful. He is intubated and ventilated using thiopentone and suxamethonium. Ten minutes later he starts to fit again. The anaesthetist suggests that propofol may help but you have heard that propofol can increase EEG activity. You wonder whether this is an appropriate drug to use.

Three part question

In [patients in resistant status epilepticus] is [propofol] effective at [reducing seizure activity]?

Search strategy

Medline 1966–12/01 using the OVID interface. [exp propofol OR propofol.mp OR diprivan.mp] AND [exp status epilepticus OR status epilepticus.mp] LIMIT to human, English, abstracts.

Search outcome

Altogether 24 papers of which six included data on patients relevant to the clinical question (table 4).

Table 4

Comment(s)

The evidence for propofol in RSE is weak. It is based on case series and small open label trials. However, there is some theoretical basis for the use of propofol in RSE and the observations made in the studies presented are encouraging. Further work is clearly needed but in refractory status epilepticus resistant to conventional treatment it would not be unreasonable to try propofol.

CLINICAL BOTTOM LINE

Propofol may be considered as a treatment for status epilepticus if conventional treatments have failed.

Report by Simon Carley,Specialist Registrar
 Checked by Ian Crawford, Research Fellow

References

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