Propofol for status epilepticus
Date First Published:
July 27, 2001
Last Updated:
March 21, 2002
Report by:
Simon Carley, SpR in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Ian Crawford, Manchester Royal Infirmary
Three-Part Question:
In [patients in resistant status epilepticus] is [propofol] effective at [reducing seizure activity]?
Clinical Scenario:
A 20 year old man presents to the emergency department in status epilepticus. Initial therapy with benzodiazepines and phenytoin is unsuccessful. He is intubated and ventilated using thiopentone and suxamethonium. 10 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.
Search Strategy:
Medline 1966-12/01 using the OVID interface.
Search Details:
[exp propofol OR propofol.mp OR diprivan.mp] AND [exp status epilepticus OR status epilepticus.mp] LIMIT to human, English, abstracts
Outcome:
24 papers of which 6 included data on patients relevant to the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Propofol infusion for control of status epilepticus. Mackenzie SJ, Kapadia F, Grant IS. 1990, Scotland | 2 patients with RSE. Standard treatment unsuccesful. | Case series | Observation of seizure activity | Propofol stopped seizure activity clinically and on EEG | Case series |
| Propofol in the treatment of convulsive status epilepticus: a report of 4 cases. Campostrini R, Bati MB, Giorgi C, et al. 1991, Italy | 4 patients on ICU with RSE | Case series | Observation of seizure activity | Propofol infusion stopped apparent seizure activity | Case series |
| Propofol in the management of refractory status epilepticus. Borgeat A, Wilder-Smith OH, Jallon P, et al. 1994, Switzerland | Adult OD patient. Propofol was given to suppress EEG activity | Case report | Observation of EEG activity | Propofol appeared to suppress EEG seizure activity | Case report |
| Propofol in prehospital treatment of convulsive status epilepticus Kuisma M, Roine RO. 1995 Finland | 8 adult patients in prehospital care with RSE. All received propofol boluses of 100-200mg. All patients were intubated and ventilated. | Case series | Success at terminating seizures | All patients stopped RSE with propofol | Case series. Not clear if patients intubated before or after propofol usage. This could be a result of the use of propofol. |
| Treatment of convulsive status epilepticus with propofol: case report. Harrison AM, Lugo RA, Schunk JE. 1998, USA | 9/12 child with hereditary fructose intolerance in RSE | Case report | Observation | RSE stopped on infusion of 3mg/Kg propofol | Case report Rare underlying disorder |
| Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Stecker MM, Kramer TH, Raps EC, et al. 1998, USA | 16 Adult patients with RSE. All patients intubated. Thiopentone (8) vs propofol (8) 1mg/kg over 5 mins, repeated if needed. |
Open trial | Time to seizure termination (elimination of EEG and clinical seizures) | Thiopentone 123 min vs propofol 2.6 min (p=0.002) | Open trial. Some of the propofol patients part of another trial, others identified retrospectively. Very small trial |
| Success at terminating seizures | Thiopentone 82% vs propofol 63% (NS) |
Author Commentary:
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 therapy it would not be unreasonable to try propofol.
Bottom Line:
Propofol may be considered as a therapy for status epilepticus if conventional therapies have failed.
References:
- Mackenzie SJ, Kapadia F, Grant IS.. Propofol infusion for control of status epilepticus.
- Campostrini R, Bati MB, Giorgi C, et al.. Propofol in the treatment of convulsive status epilepticus: a report of 4 cases.
- Borgeat A, Wilder-Smith OH, Jallon P, et al.. Propofol in the management of refractory status epilepticus.
- Kuisma M, Roine RO.. Propofol in prehospital treatment of convulsive status epilepticus
- Harrison AM, Lugo RA, Schunk JE.. Treatment of convulsive status epilepticus with propofol: case report.
- Stecker MM, Kramer TH, Raps EC, et al.. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings.