The pattern of 72-kDa heat shock protein-like immunoreactivity in the rat brain following flurothyl-induced status epilepticus

The inducible 72-kDa heat shock protein (HSP72) is a highly conserved stress protein that is expressed in CNS cells and may play a role in protection from neural injury. We used a monoclonal antibody to HSP72 and immunocytochemistry to localize HSP72 in the rat brain 24 h following either 30 or 60 min of flurothyl-induced status epilepticus. Sprague-Dawley rats were anesthetized with halothane, paralyzed, and ventilated, and remained normotensive and well oxygenated for the duration of the seizures. Seizure activity was quantified via analysis of the scalp EEG pattern. HSP72-like immunoreactivity (HSP72-LI) was induced in specific brain regions in a graded fashion that correlated, in part, with the duration and degree of seizure activity. Milder seizures produced HSP72-LI limited to layers 2 and 3 of frontoparietal cortex, dentate hilus cells, and CA3 pyramidal neurons. More extensive seizures led to HSP72-LI in layers 2, 3 and 5 of frontoparietal and visual cortex, dentate hilus cells, CA1 and CA3 pyramidal neurons, and certain thalamic and amygdaloid nuclei. These are similar to many, but not all, of the brain regions known to be injured with this model. No HSP72-LI was observed in sham-treated controls or flurothyl-treated animals whose seizures were controlled with pentobarbital. HSP72-LI thus localizes to certain regions of seizure-induced injury, and may provide a sensitive method of detecting neuronal 'stress' or injury relatively soon after status epilepticus. Whether or not HSP72 synthesis plays a protective role in the pathogenesis of seizures, or is only a marker for cell injury, remains to be determined.     

Periictal diffusion abnormalities of the thalamus in partial status epilepticus

Purpose:   To identify and describe thalamic dysfunction in patients with temporal as well as extratemporal status epilepticus (SE) and to also analyze the specific clinical, radiological, and electroencephalography (EEG) characteristics of patients with acute thalamic involvement.
Methods:   We retrospectively identified patients who presented with clinical and electrographic evidence of partial SE and had thalamic abnormalities on diffusion-weighted imaging (DWI) within 5  days of documentation of lateralized epileptiform discharges (group 1). The spatial and temporal characteristics of the periodic lateralized epileptiform discharges (PLEDs) and the recorded electrographic seizures were analyzed and correlated with magnetic resonance imaging (MRI)-DWI hyperintense lesions. The findings of group 1 patients were compared with those of patients with partial SE without thalamic abnormalities on DWI (group 2).
Results:   The two groups were similar with regard to clinical presentation and morphology of epileptiform discharges. Group 1 patients had thalamic hyperintense lesions on DWI that appeared in the region of the pulvinar nucleus, ipsilateral to the epileptiform activity. Statistically significant relationship was noted between the presence of thalamic lesions and ipsilateral cortical laminar involvement (p = 0.039) as well as seizure origin in the posterior quadrants (p = 0.038). A trend towards PLEDs originating in the posterior quadrants was also noted (p = 0.077).
Discussion:   Thalamic DWI hyperintense lesions may be observed after prolonged partial SE and are likely the result of excessive activity in thalamic nuclei having reciprocal connections with the involved cortex. The thalamus likely participates in the evolution and propagation of partial seizures in SE.     

槲皮素对大鼠癫痫持续状态后海马XIAP mRNA与蛋白表达的影响

目的研究大鼠癫痫持续状态(SE)后海马组织XIAP的表达变化及槲皮素对其表达的影响。方法建立氯化锂-匹罗卡品致痫大鼠SE模型,应用免疫组化和RT-PCR方法检测XIAP与caspase-3蛋白以及XIAP mRNA的表达。结果海马CA3区XIAP蛋白在SE后2 h(0.5503±0.0172)起逐渐增加,8 h(0.6221±0.0238)达高峰,与对照组比较(0.1507±0.0165),差异有统计学意义(P<0.01)。海马CA3区caspase-3活性蛋白在对照组未见明显表达,在SE后4~72 h明显增多。与对照组比较,SE组海马XIAP mRNA表达水平在2~8 h增加(P<0.01)。与SE组比较,槲皮素组海马XIAP mRNA表达水平及CA3区XIAP蛋白表达在8 h、24 h高于SE组(P<0.01),CA3区caspase-3活性蛋白表达在8 h、24 h、72 h低于SE组(P<0.01)。结论XIAP可能参与了SE后神经元凋亡的调控过程,槲皮素可以提高SE后海马神经元XIAP的表达。     

Age-dependent cyclooxygenase-2 induction and neuronal damage after status epilepticus in the postnatal rat hippocampus

PURPOSE: Epileptic seizures lead to age-dependent neuronal damage in the developing brain, particularly in the hippocampus, but the mechanisms involved have remained poorly elucidated. In this study, we investigated the contribution of apoptosis and inflammatory processes to neuronal damage after status epilepticus (SE) in postnatal rats. METHODS: SE was induced by an intraperitoneal injection of kainic acid (KA) in 21- and 9-day-old (P21 and P9) rats. The expression of Bax, Bcl-2 and caspase-3, markers for apoptosis, and cyclooxygenase-2 (COX-2), an indicator for activation of inflammatory processes, were studied from 6 h up to 1 week after SE by Western blotting and immunocytochemistry. Neuronal damage was verified by Fluoro-Jade B staining. RESULTS: In P21 rats, SE resulted in neuronal damage in the CA1 neurons of the hippocampus. COX-2 expression was extensively, but transiently, increased and its immunoreactivity pronouncedly enhanced in several hippocampal subregions, amygdala, and piriform cortex by 24 h after SE. The expression of Bax and caspase-3 remained unchanged, whereas the antiapoptotic factor Bcl-2 transiently decreased by 24 h. Single caspase-3 positive neurons appeared in the CA1 region of both control and KA-treated rats. In P9 rats, no neuronal death was detected, and COX-2 expression and immunoreactivity remained at the control level. DISCUSSION: Our results suggest that SE provokes age-specific effects on COX-2 expression. This together with the activation of putative inflammatory processes may contribute to neuronal cell death in the hippocampus of postnatal rats, whereas caspase-dependent apoptosis seems not to be involved in the death process.     

持续惊厥后影响海马神经元凋亡的相关因素

目的探讨年龄、惊厥持续时间对持续惊厥(status convulsion,SC)后海马神经元凋亡的影响。方法制作幼年和成年Wistar鼠SC模型,于SC持续30min及3h后不同时间点处死,TUNEL染色观察凋亡细胞的类型和分布;Annexin-Ⅴ染色,流式细胞仪定量分析凋亡过程。结果(1)SC持续30min后3h,幼年和成年鼠海马凋亡细胞[分别为(0.55%±0.21%)和(0.53%±0.06%)]较惊厥前均有显著增加。凋亡过程持续3~7d。(2)除SC持续30min后3h以外,在其他各观察时点上,幼年组海马凋亡细胞数量均低于成年组。(3)SC持续3h后,海马凋亡细胞均高于SC持续30min实验组,以成年组更为明显。结论惊厥后海马神经元凋亡与年龄和惊厥持续时间呈明显正相关。     

甘草甜素对癫痫持续状态大鼠神经保护作用及机制研究

目的研究甘草甜素(glycyrrhizin,GL)对癫痫持续状态大鼠(status epilepticus,SE)神经损伤保护作用及相关分子机制。方法取清洁健康成年雄性SD大鼠60只,采用腹腔注射氯化锂-匹罗卡品的方法建立大鼠癫痫持续状态(SE)模型,随机分为甘草甜素组(SE+GL)和生理盐水组(SE+S),分别经尾静脉给予甘草甜素及生理盐水进行干预,取正常大鼠作为对照组(control group,C);根据给予GL剂量不同将其分为高剂量组(HGL,20 mg/kg)、中剂量组(MGL,10 mg/kg)及低剂量组(LGL,5 mg/kg);通过尼氏染色(NS)观察各组大鼠SE后24 h时大脑皮质神经元损伤情况,分别采用酶联免疫吸附法(ELISA)和蛋白印迹实验(Western blot)检测各组大鼠SE后24 h时血清及大脑皮质中高迁移率族蛋白(HMGB1)的表达水平。结果 SE+S组大鼠大脑皮质神经元在癫痫持续状态后24 h明显受损,SE+GL各组皮质受损神经元数量较SE+S组减少,且在不同给药剂量组间存在显著差异(P0.05);SE+GL各组在SE后24 h时大脑皮质及血清中HMGB1的表达水平较SE+S组显著降低,差异具有统计学意义(P0.05)。结论经尾静脉给予GL能有效地减少SE后大鼠大脑皮质神经元损伤,且其神经保护作用呈剂量依赖性,其机制可能与其抑制血清及大脑皮质炎性因子HMGB1的表达有关。     

Cerebral blood flow changes during pilocarpine-induced status epilepticus activity in the rat hippocampus

Introduction

There is a known relationship between convulsive status epilepticus (SE) and hippocampal injury. Although the precise causes of this hippocampal vulnerability remains uncertain, potential mechanisms include excitotoxicity and ischaemia. It has been hypothesised that during the early phase of seizures, cerebral blood flow (CBF) increases in the cortex to meet energy demand, but it is unclear whether these compensatory mechanisms occur in the hippocampus. In this study we investigated CBF changes using perfusion MRI during SE in the pilocarpine rat.

Methods

First, we determined whether SE could be induced under anaesthesia. Two anaesthetic protocols were investigated: isoflurane (n = 6) and fentanyl/medetomidine (n = 7). Intrahippocampal EEG electrodes were used to determine seizure activity and reflex behaviours were used to assess anaesthesia. Pilocarpine was administered to induce status epilepticus. For CBF measurements, MRI arterial spin labelling was performed continuously for up to 3 h. Either pilocarpine (375 mg/kg) (n = 7) for induction of SE or saline (n = 6) was administered. Diazepam (10 mg/kg) was administered i.p. 90 min after the onset of SE.

Results and discussion

We demonstrated time-dependent significant (p < 0.05) differences between the CBF responses in the parietal cortex and the hippocampus during SE. This regional response indicates a preferential distribution of flow to certain regions of the brain and may contribute to the selective vulnerability observed in the hippocampus in humans.     

海藻氨酸致癫痫状态大鼠海马区神经元损伤与Mg^2＋作用的研究

目的观察海藻氨酸(KA)诱导的癫癎状态(SE)大鼠海马神经元的形态学改变和Mg2+的神经保护作用.方法选用成年雄性Wistar大鼠75只,随机分为KA组、Mg2+组和生理盐水对照组.用KA诱导大鼠SE 3 h,Mg2+组大鼠在注射KA前腹腔内注射硫酸镁100 mg/kg,在癫癎发作终止后72 h将动物处死,分别用光镜和电镜观察海马神经元形态学改变.结果 KA组大鼠注射KA后(16.1±4.7)min出现癫癎发作,Mg2+组大鼠为(25.4±6.2)min,两组比较差异有显著性(P<0.05).KA组和Mg2+组大鼠在海马区均出现了嗜酸性神经元,Mg2+组大鼠神经元损伤程度明显低于KA组.结论 KA诱导的SE可导致海马神经元坏死,而 Mg2+作为兴奋性氨基酸拮抗剂对海马神经元具有保护作用.     

The history of status epilepticus and its treatment

Despite the fact that status epilepticus was been recognized since antiquity, its existence was largely ignored until the mid-nineteenth century. In this review we cover the medical literature of status epilepticus from the late nineteenth century until the early 1970s when the modern era of status epilepticus began. We pay particular attention to the impact of the ILAE and its principal members on the understanding and awareness of status epilepticus. We also cover the evolution of treatment regimens advocated for status epilepticus from the late nineteenth century to the early 1970s when the benzodiazepines were established as first line treatments.     

Levetiracetam: antiepileptic properties and protective effects on mitochondrial dysfunction in experimental status epilepticus

PURPOSE: To assess the anticonvulsant activity of the novel antiepileptic drug, levetiracetam (LEV) in a model of self-sustaining limbic status epilepticus, and to measure the consequence of LEV treatment on the pattern of mitochondrial dysfunction known to occur after status epilepticus (SE). METHODS: The rat perforant pathway was stimulated for 2 h to induce self-sustaining status epilepticus (SSSE). Stimulated rats were assigned to one of three treatment groups, receiving intraperitoneal injections of saline, 200 mg/kg LEV, or 1,000 mg/kg LEV, 15 min into SSSE and at 3 times over the next 44-h period. All animals received diazepam after 3-h SSSE to terminate seizures. Forty-four hours later, the hippocampi were extracted and prepared for electrochemical high-performance liquid chromatography (HPLC), to measure reduced glutathione levels, and for spectrophotometric assays to measure activities of mitochondrial enzymes (aconitase, alpha-ketoglutarate dehydrogenase, citrate synthase, complex I, and complex II/III). These parameters were compared between treatment groups and with sham-operated rats. RESULTS: LEV administration did not terminate seizures or have any significant effect on spike frequency, although rats that received 1,000 mg/kg LEV did exhibit improved behavioral seizure parameters. Significant biochemical changes occurred in saline-treated stimulated rats compared with shams: with reductions in glutathione, alpha-ketoglutarate dehydrogenase, aconitase, citrate synthase, and complex I activities. Complex II/III activities were unchanged throughout. Rats that received 1,000 mg/kg LEV had significantly improved biochemical parameters, in many instances, comparable to sham control levels. CONCLUSIONS: Despite continuing seizures, administration of LEV (1,000 mg/kg) protects against mitochondrial dysfunction, indicating that in addition to its antiepileptic actions, LEV may have neuroprotective effects.     

Incidence and short-term prognosis of status epilepticus in adults in Bologna,Italy

PURPOSE: To determine the incidence and the 30-day case fatality of status epilepticus (SE) in the adult resident population of the city of Bologna, Italy. METHODS: Over a 1-year period (March 1, 1999 to February 29, 2000), all patients older than 20 years with SE were included. The case-finding method was based on (a) a prospective surveillance of all public general hospitals in the city by neurologic units, and (b) a review of all discharge codes concerning epilepsy. RESULTS: The crude and standardized annual incidence rate of SE was 13.1 per 100,000 [95% confidence interval (CI), 9.5-17.5] and 10.7 (95% CI, 7.5-13.8). It was higher in the elderly (older than 60 years) than in young adults (26.2 vs. 5.2) and in women than in men (14.9 vs. 11.0). Acute symptomatic SE accounted for 48%, and a cerebrovascular pathology was the most frequently associated etiologic condition (41%). A history of seizures was reported in 39% of patients. The 30-day case fatality was 39% (33% excluding postanoxic patients). CONCLUSIONS: This study reports the first data on the epidemiology of SE in Italy. The incidence rate found in the population of Bologna is in the same range as that of the other European countries. The 30-day case fatality is higher than all the other population studies (both European and American), despite the broadly similar clinical features of patients. Indirect evidence suggests that some inaccurate patient management could have negatively influenced the outcome of SE.     

癫痫持续状态后大鼠海马区钾离子通道Kv1.3的表达研究

目的研究氯化锂-匹罗卡品致癫痫持续状态(status epilepticus,SE)后大鼠海马区钾离子通道Kv1.3的表达及分布变化,探讨钾离子通道Kv1.3与癫痫发作的相关性。方法 48只健康雄性sprague-dawley大鼠随机平分为实验组和对照组,每组继续随机分为6 h、1 d、2 d和3 d 4个观察时间点亚组(n=6)。通过大鼠脑电监测记录大鼠脑电变化情况,通过尼氏染色观察脑组织病理改变,采用免疫组织化学染色和Western-blot方法检测各时间点大鼠海马区Kv1.3的表达及分布变化。结果 (1)脑电监测:正常大鼠脑电图表现为波幅较均匀一致的α波,痫性发作后开始出现慢波、棘波,波幅、节律不规则,SE过程中表现为长程的棘波活动。(2)尼氏染色:SE后6 h未发现明显形态学及神经元数量改变;SE后1 d,海马区神经元结构松散,神经元数量减少;SE后2 d、3 d,海马区神经元进一步减少,且出现神经元肿胀、变形、尼氏小体减少甚至消失。(3)免疫组织化学染色和Western-blot检测:SE后2 d,Kv1.3在海马CA_3和CA_1区表达较对照组明显减少(P0.05)。SE后6 h、1 d、3 d,Kv1.3在海马CA_3和CA_1区表达较对照组无明显变化(P0.05)。SE后6 h、1 d、2 d、3 d,Kv1.3在海马DG区表达较对照组无明显差异(P0.05)。结论 Kv1.3的表达下调可能与癫痫发作相关。     

红藻氨酸致癫痫持续状态大鼠海马neuropilin-2 mRNA及其蛋白表达的研究

目的研究轴索导向分子NPN-2mRNA及其蛋白对癫痫持续状态(SE)后大鼠海马内神经纤维外向性生长和突触重建中的调控作用。方法采用侧脑室内注射红藻氨酸(KA)制作TLE大鼠模型,用Nissl染色、原位杂交和免疫组织化学的方法,分别检测致SE后1d、1w、2w、3w、4w大鼠海马齿状回(DG)、CA1区、CA3区、门区神经元丢失程度以及NPN-2mRNA及其蛋白的表达。结果 KA致SE后1d开始出现神经元丢失,至4w神经元丢失明显增多。KA致SE后1d,NPN-2mRNA及其蛋白在DG和CA1区表达明显下降,持续至3w(P0.01),4w恢复至正常(P0.05);NPN-2mRNA及其蛋白在门区、CA3区表达实验组与对照组无明显差别(P0.05)。结论 KA致SE后,海马DG及CA1区神经元下调NPN-2mRNA及其蛋白的表达,促进DG及CA1区神经纤维外向性生长和突触的重建。     

The ketogenic diet in treatment of two adults with prolonged nonconvulsive status epilepticus

Prolonged status epilepticus (SE) can be refractory to conventional interventions, with high rates of subsequent morbidity and mortality. A high fat, low protein, low carbohydrate ketogenic diet (KD) has been used successfully to treat intractable epilepsy. However, its possible role in prolonged SE has not been well described. We report successful use of the KD in two adult patients with prolonged nonconvulsive SE (NCSE) refractory to multiple other interventions. Our observations suggest induction of ketosis may be a novel strategy to safely and effectively treat status in adults even after weeks to months of refractory seizures. Although there are few data regarding the use of the ketogenic diet in the treatment of adult epilepsy syndromes, it may be an option for the treatment of adults with refractory, prolonged SE.     

Isoflurane anaesthesia in the treatment of convulsive status epilepticus

Summary Status epilepticus may be resistant to intravenous anticonvulsive drugs. In these cases treatment with the inhalation anaesthetic agent isoflurane may be helpful in the further management. We describe a 35-year-old female patient who suffered from status epilepticus with partial seizures. In spite of therapy with benzodiazepine and phenytoin the status evolved into tonic clonic seizures. Treatment with thiopentone sodium did not stop seizure activity. Anaesthesia with isoflurane (dosage up to 1.5 vol.%) carried out twice within 72 h finally led to a termination of status epilepticus. From our own experience and reports in the literature we conclude that general anaesthesia with isoflurane can and should be used in the treatment of severe status epilepticus that does not respond to intravenous anticonvulsive agents.     

Characterization of pharmacoresistance to benzodiazepines in the rat Li-pilocarpine model of status epilepticus

Status epilepticus is usually initially treated with a benzodiazepine such as diazepam. During prolonged seizures, however, patients often lose their sensitivity to benzodiazepines, thus developing pharmacoresistant seizures. In rats, administration of LiCl followed 20–24 h later by pilocarpine induces a continuous, self-sustained, and reproducible form of status epilepticus that can be terminated with diazepam when it is administered soon after the pilocarpine injection. However, when administered after a 45 min delay, diazepam is less effective. Previous findings have suggested that the development of pharmacoresistance is related to the stage of status epilepticus. In the present study, we characterized the seizure stage-dependence of diazepam pharmacoresistance. Following administration of different doses of diazepam at varying time intervals after specific behaviorally- and electrographically-defined seizure stages, stage-, time-, and dose-dependent pharmacoresistance to diazepam developed. We also studied two other antiepileptic drugs commonly used in the treatment of status epilepticus, phenobarbital and phenytoin. Consistent with previous studies, our results indicated a similar relationship between stage, time and dose for phenobarbital, but not for phenytoin. Our data are consistent with rapid modulation of GABA_A receptors during status epilepticus that may result in pharmacoresistance to antiepileptic drugs that enhance GABA_A receptor-mediated inhibition.     

马桑内酯致大鼠癫痫持续状态后海马神经细胞凋亡的观察

观察马桑内酯（ｃｏｒｉａｒｉａｌａｃｔｏｎｅ，ＣＬ）诱导鼠癫痫持续状态（ＳＥ）时海马细胞中ＤＮＡ损伤及凋亡现象。方法用流式细胞术检测海马细胞中ＤＮＡ状态，用免疫组织化学方法显示海马谷氨酸阳性细胞，并以流式细胞术免疫荧光法测定海马细胞中ＢＣＬ－２样蛋白含量。结果ＳＥ后海马细胞中有ＤＮＡ损伤断裂；海马ＣＡ３区谷氨酸阳性细胞数量减少，着色变淡；海马细胞中ＢＣＬ－２样蛋白增加。结论ＳＥ可诱导海马细胞ＤＮＡ损伤进而凋亡；ＳＥ时谷氨酸过量释放可造成突触后靶细胞损伤。ＢＣＬ－２样蛋白增加可能是ＢＣＬ－２家族蛋白共同变化的结果，是细胞自身的保护机制，以抗损伤和凋亡。     

大鼠癫(癎)持续状态后海马内X-连锁凋亡抑制蛋白及其负性调控因子的表达

目的 研究大鼠癫(癎)持续状态(SE)后海马组织中X-连锁凋亡抑制蛋白(XIAP)及其负性调控因子Smac、HtrA2、XAF1的表达变化.方法 建立氯化锂-匹罗卡品致(癎)大鼠SE模型,应用免疫组织化学染色和Western blot方法检测大鼠SE后各时点海马CA3区XIAP、Smac、HtrA2、XAF1及半胱氨酸蛋白酶(caspase)-3蛋白的表达.结果 SE后大鼠海马CA3区XIAP蛋白呈弥散性分布于整个神经元内,SE后2 h(0.5503±0.0172)起逐渐增高(t=115.87),8 h(0.6221±0.0238)达高峰(t=136.69).与对照组(0.1507±0.0165)比较,差异有统计学意义(P<0.01).Same、HtrA2及XAF1蛋白在对照组弱表达,在SE后呈弥散性分布于整个神经元内.2～72 h增高.海马CA3区caspase-3活性蛋白在对照组呈阴性,在SE后4～72 h明显增高.Western blot发现,SE组各时间点XIAP蛋白表达量与对照组比较差异无统计学意义(P>0.05),Smac、HtrA2及caspese-3蛋白在对照组很少表达,在SE后2～72 h增高(P<0.01).结论 XIAP及其负性调控因子Smac、HtrA2、XAF1涉及了SE后神经元凋亡的调节,参与了SE后神经元损伤.     

咪达唑仑持续静脉维持治疗儿童癫持续状态疗效观察

目的观察咪达唑仑持续静脉维持治疗癫持续状态(SE)的疗效。方法38例SE患儿应用咪达唑仑持续静脉维持治疗,开始以0.1～0.2mg/kg静脉注射,随后以0.1～0.4mg/(kg.h)持续静脉维持,根据发作状态调整剂量大小。结果26例SE患儿应用咪达唑仑维持治疗后样发作停止。4例患儿症状部分缓解,6例患儿无效,2例患儿因基础疾病死亡。咪达唑仑应用过程中无严重不良反应出现。结论应用咪达唑仑治疗SE有效安全。     

Pentobarbital and EEG burst suppression in treatment of status epilepticus refractory to benzodiazepines and phenytoin

Seven patients with complex partial or secondarily generalized tonic-clonic status epilepticus (SE) refractory to benzodiazepines (BZDs) and phenytoin (PHT) were treated with pentobarbital (PTB) coma with an EEG burst suppression (BSP) pattern. PTB administered by continuous intravenous (i.v.) infusion pump at a loading dose of 6-8 mg/kg in 40-60 min was usually sufficient to produce BSP activity and seizure control. PTB was continued 0-24 h at 1-4 mg/kg/h, adjusted to maintain blood pressure (BP) and BSP. Infusion rate was decreased if systolic BP (SBP) was less than 90 mm Hg. Normal saline fluid challenge was occasionally used to elevate BP, but in no case was it necessary to discontinue PTB infusion or use pressors. Other antiepileptic drugs (AEDs) were maintained at therapeutic levels for chronic seizure protection. Seizures were stopped in all cases. Four patients attained premorbid neurologic status, two patients briefly survived in vegetative states with recurring seizures after PTB withdrawal, and one patient died of asystole after receiving PTB for 7 h. Patients who had poor outcomes had prolonged seizures (16 h to 3 weeks) before institution of PTB anesthesia, and all had significant underlying central nervous system (CNS) pathology. PTB-induced BSP appears to be safe and effective for refractory SE if it is started soon after failure of a BZD and PHT. Ultimate prognosis depends on SE etiology.