Palliative Sedation for Status Epilepticus in a Patient with Progressive Multifocal Leukoencephalopathy

• Published in: Journal of pain & palliative care pharmacotherapy Vol. 28; no. 4; pp. 382 - 383
• Main Authors: Cancelli, Ferdinando, Dubra, Alexandre, Zulian, Gilbert B.
• Format: Journal Article
• Language: English
• Published: England Informa Healthcare 01-12-2014; Taylor & Francis
• Subjects: Adult; Humans; Hypnotics and Sedatives - therapeutic use; Leukoencephalopathy, Progressive Multifocal - complications; Leukoencephalopathy, Progressive Multifocal - drug therapy; Male; midazolam; Midazolam - therapeutic use; palliative; Palliative Care - methods; progressive multifocal leukoencephalopathy; sedation; status epilepticus; Status Epilepticus - complications; Status Epilepticus - drug therapy; status epilepticus; palliative; midazolam; progressive multifocal leukoencephalopathy; sedation
• ISSN: 1536-0288; 1536-0539
• DOI: 10.3109/15360288.2014.969873

ABSTRACT
Palliative sedation is defined as the use of sedative drugs in order to reduce the patient's consciousness in case of refractory symptoms. The most used drug is midazolam, a benzodiazepine with a short half-life administered either intravenously or subcutaneously. We discuss on a clinical case requiring an exceptionally high dosage of midazolam-up to 160 mg iv daily-to achieve palliative sedation. The patient was an HIV positive 29-year-old male who was suffering from progressive multifocal leukoencephalopathy complicated by a refractory status epilepticus and who was suspected of previous benzodiazepines and opioid abuse. In such situations of a suffering brain doses of midazolam to achieve symptom control may be much higher than expected.