Critical Care Unit, Kasetsart University Veterinary Teaching Hospital, Thailand
Refractory status epilepsy is commonly neurological emergency with high mortality and morbidity rate. This is a life-threatening condition particularly if the proper treatment is delayed. Super-refractory status epilepticus is a late stage of refractory status epilepticus characterized by unresponsiveness to the initial anesthetic therapy. There is a new concept that has been the focus of recent basic and therapeutic works, is defined as status epilepticus that continuous or recurs 24 hours or more after onset of anesthesia including those cases in which status epilepticus recurs on the reduction or withdrawal of anesthesia. This is the first case report of super-refractory status epilepticus in Thailand. An 8 months old, intact male Shih-Tzu dog presented with status epilepticus. Magnetic resonance imaging and computed tomography (CT scan) were not found structural abnormalities.
Blood works were normal. Cerebrospinal fluid cytology showed mild mononuclear pleocytosis. Bacterial and fungal culture have no growth. The dog still had status epilepticus and did not respond to combination of high dose oral anti-epileptic drugs (phenobarbital, potassium bromide, levetiracetam, gabapentin) with continuous rate infusion of propofol, diazepam, pentobarbital and ketamine, respectively. During procedure full monitoring with electroencephalography (EEG), showed EEG seizures continuously on left hemisphere maximum at parietal area. Ultimately, anesthesia with continuous isoflurane inhalation to stage 3 plane 2 was performed for 10 hours. Effective to stop status epilepticus, EEG showed burst suppression (1/10 second) and then taper off isoflurane. Gradually the dog became successful recovery and responsiveness. In this case showed therapeutic option to control super-refractory status epilepticus for a favorable outcome.