"Keep in mind you do not want a neuromuscular blockade," Dr. Likosky said. "It’s easy to stop convulsions [via paralysis] but it doesn’t really do what you want," which is normalizing the EEG.
The goal for the EEG changes is a transformation of the spike/wave epileptiform pattern to burst suppression – a pattern of flatter lines interrupted by bursts of electrical discharge. Motor symptoms are not a reliable indicator of ongoing seizure activity.
Several studies have shown that EEG status can persist after motor symptoms resolve, Dr. Likosky said. A 1996 study highlights this phenomenon. Of 164 patients treated for convulsive status epilepticus, 48% still showed persistent electrographic seizure activity after their motor seizures ceased (Epilepsia 1998;39:833-40).
These patients must be treated aggressively with regular lightening of sedating medications, accompanied by an assessment of their clinical picture and EEG findings.
Dr. Likosky reported having no financial disclosures relevant to his lecture.