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Journal of Pediatric Epilepsy 2022; 11(03): 090-094
DOI: 10.1055/s-0041-1740112
Case Report

Successful Use of Inhalational Anesthesia and Electroconvulsive Therapy in a Child with New Onset Prolonged Super-Refractory Status Epilepticus

Bharat Mehra 
1   Pediatric Intensive Care Unit, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, India
,
Ramakant Sabharwal
2   Division of Pediatric Neurology, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, India
,
Anil Sachdev
1   Pediatric Intensive Care Unit, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, India
,
Praveen Kumar
2   Division of Pediatric Neurology, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, India
,
Rajiv Mehta
3   Institute of Psychiatry and Behavioural Sciences, Sir Ganga Ram Hospital, Delhi, India
,
Neeraj Gupta
1   Pediatric Intensive Care Unit, Institute of Child Health, Sir Ganga Ram Hospital, Delhi, India
› Author Affiliations Funding None.
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Abstract

The treatment of super-refractory status epilepticus (SRSE) and prolonged SRSE rests on urgent seizure control to minimize excitotoxic cerebral damage, other forms of neurologic damage, and multiple medical complications. To date no randomized controlled trials or clear-cut guidelines are available for the management of SRSE. We reported the case of a 10-year-old previously healthy male child patient who presented with a febrile illness and new onset prolonged SRSE that became refractory to multiple antiseizure medications (ASMs). Coma induction with anesthetic agents, 14 ASMs, ketogenic diet, immunotherapy failed to completely control the SRSE in our patient. On day 22, clinical and electroencephalographic seizure control was achieved with isoflurane inhalation anesthesia, which was continued for 3 weeks but was unable to be weaned. From day 57 onwards, electroconvulsive therapy was administered (total 14 sessions that resulted in complete control of seizures). He was discharged on the 80th day.

Keywords

status epilepticus - super-refractory status epilepticus - electroconvulsive therapy - ketamine - isoflurane - FIRES


Publication History

Received: 14 July 2021

Accepted: 14 October 2021

Article published online:
02 December 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
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