Adjunctive enteral phenobarbital for adult status epilepticus: a brief report
A female, aged 15 years, with systemic lupus erythematosus was admitted due to seizures and diagnosed with central nervous system (CNS) vasculitis. A CT scan of the brain was normal, and the CSF had a mild elevation of protein, at 50 mg/dL. She was given 1 gm of methyl prednisolone IV for 3 days. She also had urinary tract infection and an infected bedsore. Previously, her seizures were controlled by 300 mg of phenytoin orally. During the admission, she developed GTCSE, and her MRI of the brain showed venous infarction with hemorrhagic transformation. The SE was uncontrolled by the IV loading of 750 mg phenytoin, 100 mg of IV sodium valproate, and 300 mg of oral topiramate. An EEG showed persistent epileptiform discharges at both parietooccipital and parasagittal areas. She was intubated and treated successfully with a 720 mg PB NG tube feeding. The seizures were recurrent 22 hours later, whereupon a reloading of 720 mg of PB enterally was prescribed for eleven times, until the seizures were completely controlled both clinically and by EEG. The PB level was 86.48 μg/mL (10–40 μg/mL). The serological tests revealed positive anti-RO, anti-RNP, and lupus anticoagulant. She was finally diagnosed as having antiphospholipid syndrome and treated with enoxaparin and dexamethasone. The patient completely recovered.