Dexamethasone as Abortive Treatment for Refractory Seizures or Status Epilepticus in the Inpatient Setting

Alexander B. Ramos, Roberto A. Cruz, Nicole R. Villemarette-Pittman, Piotr W. Olejniczak, Edward C. Mader

Research output: Contribution to journalArticle

Abstract

Refractory seizures or status epilepticus (RS/SE) continues to be a challenge in the inpatient setting. Failure to abort a seizure with antiepileptic drugs (AEDs) may lead to intubation and treatment with general anesthesia exposing patients to complications, extending hospitalization, and increasing the cost of care. Studies have shown a key role of inflammatory mediators in seizure generation and termination. We describe 4 patients with RS/SE that was aborted when dexamethasone was added to conventional AEDs: a 61-year-old female with temporal lobe epilepsy who presented with delirium, nonconvulsive status epilepticus, and oculomyoclonic status; a 56-year-old female with history of traumatic left frontal lobe hemorrhage who developed right face and hand epilepsia partialis continua followed by refractory focal clonic seizures; a 51-year-old male with history of traumatic intracranial hemorrhage who exhibited left-sided epilepsia partialis continua; and a 75-year-old female with history of breast cancer who manifested nonconvulsive status epilepticus and refractory focal clonic seizures. All patients continued experiencing RS/SE despite first- and second-line therapy, and one patient continued to experience RS/SE despite third-line therapy. Failure to abort RS/SE with conventional therapy motivated us to administer intravenous dexamethasone. A 10-mg load was given (except in one patient) followed by 4.0- 5.2 mg q6h. All clinical and electrographic seizures stopped 3-4 days after starting dexamethasone. When dexamethasone was discontinued 1-3 days after seizures stopped, all patients remained seizure-free on 2-3 AEDs. The cessation of RS/SE when dexamethasone was added to conventional antiseizure therapy suggests that inflammatory processes are involved in the pathogenesis of RS/SE.

Original languageEnglish (US)
JournalJournal of Investigative Medicine High Impact Case Reports
Volume7
DOIs
StatePublished - May 1 2019

Fingerprint

Status Epilepticus
seizure
Refractory materials
Dexamethasone
Inpatients
Seizures
Epilepsy, Partial, Motor
Epilepsia Partialis Continua
Therapeutics
Anticonvulsants
drug
Traumatic Intracranial Hemorrhage
Temporal Lobe Epilepsy
Delirium
Frontal Lobe
epilepsy
Intubation
General Anesthesia
history
hospitalization

Keywords

  • anti-inflammatory
  • antiepileptic drugs
  • dexamethasone
  • inflammation
  • refractory seizures
  • status epilepticus
  • steroid

ASJC Scopus subject areas

  • Epidemiology
  • Safety, Risk, Reliability and Quality
  • Safety Research

Cite this

Dexamethasone as Abortive Treatment for Refractory Seizures or Status Epilepticus in the Inpatient Setting. / Ramos, Alexander B.; Cruz, Roberto A.; Villemarette-Pittman, Nicole R.; Olejniczak, Piotr W.; Mader, Edward C.

In: Journal of Investigative Medicine High Impact Case Reports, Vol. 7, 01.05.2019.

Research output: Contribution to journalArticle

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