Treat the Patient, Not the Test When a Hospitalized Patient in Status Epilepticus Transitions to Comfort-Focused Goals of Care. J Palliat Med 2018 Aug;21(8):1195-1198
Date
06/30/2018Pubmed ID
29958033DOI
10.1089/jpm.2018.0119Scopus ID
2-s2.0-85052309159 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
Status epilepticus is a common and under-recognized cause of unconsciousness among hospitalized patients. It can clinically mimic delirium and other causes of acute mental status change, especially when clinically relevant seizure activity is not appreciated on physical examination. While the successful treatment of status epilepticus may require anesthetic dosing of antiepileptics such as barbiturates, these seemingly drastic therapeutic measures are justified when goals of care are life prolonging as they may allow a patient to regain consciousness and meaningfully interact with loved ones. However, medical burden from electroencephalogram (EEG) monitoring and other care associated with its diagnosis and treatment can contribute to distress for patients who may be dying from a comorbid illness. Furthermore, when goals of care transition to comfort, care challenges can result regarding the ongoing management of barbiturates or other sedatives, previously prescribed to treat the status epilepticus. In this case study, the lack of clinically significant seizure activity led us to conclude that the discontinuation of a barbiturate infusion and the EEG monitoring was the clinically appropriate approach for a dying patient with comfort goals of care and nonconvulsive status epilepticus.
Author List
Marks S, Williams A, Peltier W, Helms A, Carlson CAuthors
Chad Carlson MD Professor in the Neurology department at Medical College of WisconsinAnn K. Helms MD Professor in the Neurology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AnticonvulsantsComorbidity
Delirium
Female
Humans
Middle Aged
Practice Guidelines as Topic
Status Epilepticus
Terminal Care
Treatment Outcome
