ROLE OF PROPOFOL IN REFRACTORY STATUS EPILEPTICUS

OBJECTIVE: To provide a review of the proposed mechanism of action, cl inical efficacy, adverse effects, and therapeutic considerations assoc iated with the use of propofol in the management of patients with refr actory status epilepticus. DATA SOURCES: A MEDLINE database (January 1 966-April 1998) was searched for literature pertaining to status epile pticus and propofol. Additional literature was obtained from the refer ences of selected articles identified in the search. information from all articles published in English was considered for inclusion in the article. DATA SYNTHESIS: Propofol is a unique, nonbarbiturate, anesthe tic agent possessing anticonvulsant properties, although the exact ant iconvulsant mechanism is unknown. Several case reports and two small, open, uncontrolled studies have described the efficacy of propofol in refractory status epilepticus. Most of these clinical reports discuss the utility of propofol after traditional treatment regimens have fail ed or are not tolerated. initiation of propofol usually resulted in te rmination of seizure activity and/or electroencephalographic burst sup pression within seconds that was sustained during the drug's use. Addi tionally, propofol was well tolerated. Advantages of propofol compared with traditional barbiturate anesthetic agents include better cardiov ascular tolerability and a more favorable pharmacokinetic profile, all owing for rapid assessment of efficacy and neurologic assessment upon drug withdrawal. Propofol has been associated with a variety of neuroe xcitatory adverse events such as opisthotonos, muscle rigidity, and ch oreoathetoid movements. Additionally, although the data are inconclusi ve, propofol has also been reported to cause seizures. CONCLUSIONS: Pr opofol has shown promising results in the management of refractory sta tus epilepticus when traditional therapies have failed or were not tol erated; however, controlled clinical trials are needed to better asses s the comparative efficacy, neurologic adverse effects, and clinical o utcome to better define its role in refractory status epilepticus.