Propofol versus thiopental sodium for the treatment of refractory status epilepticus. 2012

Hemanshu Prabhakar, and Ashish Bindra, and Gyaninder Pal Singh, and Mani Kalaivani
Department of Neuroanaesthesiology, All India Institute of Medical Sciences, New Delhi, India. prabhakaraiims@yahoo.co.in.

BACKGROUND Failure to respond to antiepileptic drugs in uncontrolled seizure activity such as refractory status epilepticus (RSE) has led to the use of anaesthetic drugs. Coma is induced with anaesthetic drugs to achieve complete control of seizure activity. Thiopental sodium and propofol are popularly used for this purpose. Both agents have been found to be effective. However, there is substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome. OBJECTIVE To compare the efficacy, adverse effects, and short- and long-term outcomes of RSE treated with one of the two anaesthetic agents, thiopental sodium or propofol. METHODS We searched the Cochrane Epilepsy Group Specialized Register (10 May 2012), the Cochrane Central Register of Controlled Trials (CENTRAL Issue 4 of 12, The Cochrane Library 2012), and MEDLINE (1946 to May week 1, 2012). We also searched (10 May 2012) ClinicalTrials.gov, The South Asian Database of Controlled Clinical Trials, and IndMED (a bibliographic database of Indian Medical Journals). METHODS All randomised or quasi-randomised controlled studies (regardless of blinding) of control of RSE using either thiopental sodium or propofol. METHODS Two review authors screened the search results and reviewed abstracts of relevant and eligible trials before retrieving the full text publications. RESULTS One study was available for review. This study was a small, single-blind, multicentre trial studying adults with RSE and receiving either propofol or thiopental sodium for the control of seizure activity (Rossetti 2011). This study showed a wide confidence interval suggesting that the drugs may differ in efficacy up to more than two-fold. There was no evidence of a difference between the drugs with respect to the outcome measures such as control of seizure activity and functional outcome at three months. CONCLUSIONS There is lack of robust and randomised controlled evidence that can clarify the efficacy of propofol and thiopental sodium over each other in the treatment of RSE. There is a need for large, randomised controlled trials for this serious condition.

UI MeSH Term Description Entries
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D000927 Anticonvulsants Drugs used to prevent SEIZURES or reduce their severity. Anticonvulsant,Anticonvulsant Drug,Anticonvulsive Agent,Anticonvulsive Drug,Antiepileptic,Antiepileptic Agent,Antiepileptic Agents,Antiepileptic Drug,Anticonvulsant Drugs,Anticonvulsive Agents,Anticonvulsive Drugs,Antiepileptic Drugs,Antiepileptics,Agent, Anticonvulsive,Agent, Antiepileptic,Agents, Anticonvulsive,Agents, Antiepileptic,Drug, Anticonvulsant,Drug, Anticonvulsive,Drug, Antiepileptic,Drugs, Anticonvulsant,Drugs, Anticonvulsive,Drugs, Antiepileptic
D013226 Status Epilepticus A prolonged seizure or seizures repeated frequently enough to prevent recovery between episodes occurring over a period of 20-30 minutes. The most common subtype is generalized tonic-clonic status epilepticus, a potentially fatal condition associated with neuronal injury and respiratory and metabolic dysfunction. Nonconvulsive forms include petit mal status and complex partial status, which may manifest as behavioral disturbances. Simple partial status epilepticus consists of persistent motor, sensory, or autonomic seizures that do not impair cognition (see also EPILEPSIA PARTIALIS CONTINUA). Subclinical status epilepticus generally refers to seizures occurring in an unresponsive or comatose individual in the absence of overt signs of seizure activity. (From N Engl J Med 1998 Apr 2;338(14):970-6; Neurologia 1997 Dec;12 Suppl 6:25-30) Absence Status,Complex Partial Status Epilepticus,Generalized Convulsive Status Epilepticus,Non-Convulsive Status Epilepticus,Petit Mal Status,Simple Partial Status Epilepticus,Grand Mal Status Epilepticus,Status Epilepticus, Complex Partial,Status Epilepticus, Electrographic,Status Epilepticus, Generalized,Status Epilepticus, Generalized Convulsive,Status Epilepticus, Grand Mal,Status Epilepticus, Non-Convulsive,Status Epilepticus, Simple Partial,Status Epilepticus, Subclinical,Electrographic Status Epilepticus,Generalized Status Epilepticus,Non Convulsive Status Epilepticus,Status Epilepticus, Non Convulsive,Status, Absence,Status, Petit Mal,Subclinical Status Epilepticus
D013874 Thiopental A barbiturate that is administered intravenously for the induction of general anesthesia or for the production of complete anesthesia of short duration. Penthiobarbital,Thiomebumal,Thiopentobarbital,Bomathal,Nesdonal,Pentothal,Pentothal Sodico,Sodipental,Thionembutal,Thiopental Nycomed,Thiopental Sodium,Thiopentone,Tiobarbital Braun,Trapanal
D015742 Propofol An intravenous anesthetic agent which has the advantage of a very rapid onset after infusion or bolus injection plus a very short recovery period of a couple of minutes. (From Smith and Reynard, Textbook of Pharmacology, 1992, 1st ed, p206). Propofol has been used as ANTICONVULSANTS and ANTIEMETICS. Disoprofol,2,6-Bis(1-methylethyl)phenol,2,6-Diisopropylphenol,Aquafol,Diprivan,Disoprivan,Fresofol,ICI-35,868,ICI-35868,Ivofol,Propofol Abbott,Propofol Fresenius,Propofol MCT,Propofol Rovi,Propofol-Lipuro,Recofol,2,6 Diisopropylphenol,ICI 35,868,ICI 35868,ICI35,868,ICI35868
D018686 Anesthetics, Intravenous Ultrashort-acting anesthetics that are used for induction. Loss of consciousness is rapid and induction is pleasant, but there is no muscle relaxation and reflexes frequently are not reduced adequately. Repeated administration results in accumulation and prolongs the recovery time. Since these agents have little if any analgesic activity, they are seldom used alone except in brief minor procedures. (From AMA Drug Evaluations Annual, 1994, p174) Intravenous Anesthetic,Intravenous Anesthetics,Anesthetic, Intravenous

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