Adjunctive enteral phenobarbital for adult status epilepticus: a brief report

Abstract

Somsak Tiamkao,1,2 Kornkanok Suttapan,1 Sineenard Pranbul,2,3 Siriporn Tiamkao,2,4 Kittisak Sawanyawisuth,1,5 Integrated Epilepsy Research group21Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; 3Nursing Division, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 4Department of Pharmacy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 5The Research and Training Center for Enhancing Quality of Life of Working-Age People, Khon Kaen University, Khon Kaen, ThailandBackground: Status epilepticus (SE) is a neurological emergency condition. Intravenous phenobarbital (PB) is recommended for refractory SE treatment. However, intravenous PB is unavailable in Thailand. Enteral PB has been shown to be effective in SE children.Methods: In adult SE patients, the efficacy of enteral PB as an adjunctive therapy has been reported. This is a case series of adult SE patients who were treated with enteral PB at Khon Kaen University Hospital, Thailand. The clinical features and clinical outcomes are reported.Results: There were six patients; five patients had convulsive SE, and one patient had nonconvulsive SE. All patients received PB enterally, at dosages of 900 mg initially and repeated doses of 900 mg as needed. This was gradually reduced to a maintenance dosage of 180 mg/day. Three out of six patients were completely controlled, whereas the other three patients were partially controlled. Three out of six patients were seizure-free after the initial loading dose of PB. No adverse effects were found in this study.Conclusion: In adult patients, enteral PB may be effective as an add-on for refractory SE therapy.Keywords: clinical outcomes, refractory status epilepticus, Thailand, efficacy