Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings

Epilepsia. 1998 Jan;39(1):18-26. doi: 10.1111/j.1528-1157.1998.tb01269.x.


Purpose: We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels.

Methods: Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol.

Results: Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) than with high-dose barbiturate therapy (82%). The time from initiation of high-dose barbiturate therapy to attainment of control of RSE was longer (123 min) than the time to attainment of seizure control in the group receiving propofol (2.6 min, p = 0.002). Plasma concentrations of propofol associated with control of SE were 14 microM +/- 4 (2.5 microg/ml). Recurrent seizures were common when propofol infusions were suddenly discontinued but not when the infusions were gradually tapered.

Conclusions: If used appropriately, propofol infusions can effectively and quickly terminate many but not all episodes of RSE. Propofol is a promising agent for use in treating RSE, but more studies are required to determine its true value in comparison with other agents.

Publication types

  • Clinical Trial
  • Comparative Study
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Barbiturates / administration & dosage
  • Barbiturates / therapeutic use
  • Clinical Protocols
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Humans
  • Hypotension / chemically induced
  • Hypotension / epidemiology
  • Infusion Pumps
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Phenobarbital / administration & dosage
  • Phenobarbital / therapeutic use
  • Phenytoin / administration & dosage
  • Phenytoin / therapeutic use
  • Propofol / blood
  • Propofol / pharmacokinetics
  • Propofol / therapeutic use*
  • Status Epilepticus / blood
  • Status Epilepticus / drug therapy*
  • Survival Analysis
  • Treatment Outcome


  • Barbiturates
  • Phenytoin
  • Propofol
  • Phenobarbital