Determine appropriate timing for weaning anesthetic agents to avoid seizure recurrence in patients with status epilepticus.

Status epilepticus (SE) is a life-threatening condition that if untreated, can lead to significant morbidity and mortality. Experts recommend a 24-48 hour timeframe of electrographic seizure control prior to slow removal of sedation agents to prevent recurrent seizures. Our aim is to determine the likelihood of recurrent seizures at varying wean times in SE patients on anesthetic agents.

Seventy-seven patients were identified. Seizure types included non-convulsive status epilepticus (NCSE) 62.3% (48/77), convulsive SE 26% (20/77), generalized tonic-clonic seizure followed by NCSE 7.8% (6/77), and myoclonic seizures 3.9% (3/77). Sedation agents included:  propofol 87% (67/77), midazolam 42.9% (33/77), and pentobarbital 2.6% (2/77). Anesthetic wean times were as follows: 24 hours or less 45.5% (35/77), 24-48 hours 14.3% (11/77), 48-72 hours 16.9% (13/77), and greater than 72 hours 15.6% (12/77). Seizure recurrence rates were as follows:  28.6% (10/35) with wean less than 24 hours, 18.2% (2/11) at 24-48 hours, 15.4% (2/13) at 48-72 hours, and 16.7% (2/12) at greater than 72 hours.

SE is life-threatening and requires patience in weaning anesthetic agents to avoid recurrence of seizures. Weaning sedation prior to 48 hours has a significantly increased risk of seizure recurrence compared to after 48 hours. In those with SE, we recommend holding anesthetic medications a minimum of 48 hours prior to a slow wean of sedation to avoid seizure recurrence. Weaning between 24 to 48 hours may be reasonable but recommend proceeding with caution.