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High‐dose phenobarbital with intermittent short‐acting barbiturates for acute encephalitis with refractory, repetitive partial seizures
Author(s) -
Uchida Takashi,
Takayanagi Masaru,
Kitamura Taro,
Nishio Toshiyuki,
Numata Yurika,
Endo Wakaba,
Haginoya Kazuhiro,
Ohura Toshihiro
Publication year - 2016
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12934
Subject(s) - medicine , phenobarbital , coma (optics) , refractory (planetary science) , barbiturate , anesthesia , pharmacology , physics , astrobiology , optics
Acute encephalitis with refractory, repetitive partial seizures (AERRPS) is characterized by repetitive seizures during the acute and chronic phases and has a poor neurological outcome. Burst‐suppression coma via continuous i.v. infusion of a short‐acting barbiturate is used to terminate refractory seizures, but the severe side‐effects of short‐acting barbiturates are problematic. We report on a 9‐year‐old boy with AERRPS who was effectively treated with very‐high‐dose phenobarbital (VHDPB) combined with intermittent short‐acting barbiturates. VHDPB side‐effects were mild, especially compared with those associated with continuous i.v. infusion of short‐acting barbiturates (dosage, 40–75 mg/kg/day; maximum blood level, 290 μg/mL). Using VHDPB as the main treatment, short‐acting barbiturates were used intermittently and in small amounts. This is the first report to show that VHDPB, combined with intermittent short‐acting barbiturates, can effectively treat AERRPS. After treatment, convulsions were suppressed and daily life continued, but intellectual impairment and high‐level dysfunction remained.