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Benzodiazepines, phenytoin had no effect on the seizures.
We paralysed him with vecuronium immediately after seizures had subsided. We couldn't arrange for EEG monitoring in the ED at that time.

This raises another question..

Can patients with refractory seizures be paralysed BEFORE controlling the seizures, when EEG monitoring is unavailable?

Paralysis with neuromuscular blocking agents will prevent manifestation of seizures. This gives a false sense of security that the seizure has subsided. The neuronal discharge in the brain will continue and will lead to cerebral edema - coning. However paralysis will prevent heat generation and muscle damage.

I feel immediate paralysis is advised only if EEG monitoring is available.

Any comments?