Abstract
Background
This is an updated version of the original Cochrane review published in Issue 8, 2012.
Failure to respond to antiepileptic drugs in patients with 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 a substantial lack of evidence as to which of the two drugs is better in terms of clinical outcome.
Objectives
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.
Search methods
We searched the Cochrane Epilepsy Group Specialized Register (26 March 2015), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 2, February 2015) and MEDLINE (1946 to 26 March 2015). We also searched ClinicalTrials.gov(26 March 2015), the South Asian Database of Controlled Clinical Trials and IndMED (a bibliographic database of Indian Medical Journals).
Selection criteria
All randomised or quasi-randomised controlled studies (regardless of blinding) of control of RSE using either thiopental sodium or propofol in patients of any age and gender.
Data collection and analysis
Two review authors screened the search results and reviewed the abstracts of relevant and eligible trials before retrieving the full-text publications.
Main results
One study with a total of 24 participants was available for review. This study was a small, single-blind, multicentre trial studying adults with RSE receiving either propofol or thiopental sodium for the control of seizure activity. This study cannot be considered of high methodological quality. This study was terminated early due to recruitment problems. This study showed a wide confidence interval suggesting that the drugs may differ in efficacy up to more than two-fold. Days of mechanical ventilation were more in patients receiving thiopental sodium when compared with propofol. At three months there was no evidence of a difference between the drugs with respect to outcome measures such as control of seizure activity and functional outcome. Adverse events reported in this study were infection, hypotension and intestinal ischaemia.
Authors’ conclusions
Since the last version of this review we have found no new studies.
There is a lack of robust, randomised, controlled evidence that can clarify the efficacy of propofol and thiopental sodium compared to each other in the treatment of RSE. There is a need for large randomised controlled trials for this serious condition.
Plain language summary
Propofol versus thiopental sodium for the treatment of refractory status epilepticus (RSE)
Persistent convulsions (lasting 30 minutes or more) are a major medical emergency associated with significant morbidity and mortality. At times, these convulsions fail to respond to first- and second-line drug therapy and may occur in up to 31% of patients suffering from persistent seizure or convulsive activities. Persistent seizure activity may become unresponsive to antiepileptic drugs. Anaesthetics such as thiopental sodium and propofol are frequently given for control of seizures in such situations. Both agents have their own side effects and complications. This review evaluates the evidence for the use of these anaesthetic drugs in controlling seizure activity in patients with RSE.
There is a lack of good-quality evidence to support the choice of anaesthetic drug for the treatment of patients with RSE. We carried out searches on 26 March 2015. Only one trial could be identified, which was terminated early due to recruitment problems. This study enrolled only 24 participants of the required 150. This study was a small, single-blind, multicentre trial studying adults with RSE receiving either propofol or thiopental sodium for the control of seizure activity.This study cannot be considered of high methodological quality. There was no difference between the two drugs in their ability to control seizure activity. The only difference noted was the requirement for prolonged mechanical ventilation for patients in the thiopental group. This could be due to the prolonged presence of the drug in the body due to its slow removal. There is a clear need for a large randomised controlled trial to study the efficacy of anaesthetic agents in the treatment of RSE.
