Isoflurane in refractory status epilepticus

One infrequently used option for refractory status epilepticus is isoflurane anaesthesia. A report of two cases demonstrates progressive MRI changes suggestive of neurotoxicity, that improved after discontinuation of isoflurane. Impossible to prove cause and effect here, since the both patients had status for weeks and were on multiple anticonvulsant medications, for example lorazepam, fosphenytoin, levetiracetam, valproate, and subsequent infusions of midazolam, pentobarbital, and ketamine. Neither patient recovered beyond a minimally conscious state. This article serves as a reminder that:

  1. Persistent status epilepticus may be associated with a poor neurologic outcome
  2. Some cases are extremely refractory to treatment
  3. Isoflurane is one of many options to try when standard anticonvulsant regimens are failing

Prolonged High-Dose Isoflurane for Refractory Status Epilepticus: Is It Safe?
Anesth Analg. 2010 Dec;111(6):1520-4

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