Adjunctive enteral phenobarbital for adult status epilepticus: a brief report
A 27-year-old female with carcinoma of the tongue stage T2N1M0, who was post-wide excision and radiotherapy, was admitted because of pneumonia. On the second day of admission, the patient had cardiac arrest from upper airway obstruction, resulting in hypoxic ischemic encephalopathy. Four days later, the patient developed tonic downward nystagmus in both eyes. An EEG revealed persistent epileptic discharge in the right temporal lobe. The diagnosis of NCSE was made, but this was not successfully controlled by 10 mg IV diazepam or 1,200 mg of IV sodium valproate. The seizures were controlled after a loading of 900 mg PB via NG tube feeding. The PB level at 7 hours after PB administration was 43.98 μg/mL (10–40 μg/mL). She received 180 mg of PB as a maintenance dose. She developed seizures again at day 12 after admission and was treated with oral topiramate. Her final status was bedridden.