Verapamil attenuates the malignant treatment course in recurrent status epilepticus

In the scenario of refractory status epilepticus, the recommended approach of intensive care treatment is limited with respect to the available pharmacodynamic variability and its impeding, severe side effects. Alternative treatment options are therefore urgently needed. In the case described, a patient with nonlesional frontal lobe epilepsy had a high-frequency series of tonic seizures, which evolved into a malignant form of status epilepticus. Co-administration of verapamil, a potent multidrug transporter inhibitor, was followed by significant reduction in seizure frequency. We discuss the putative role of verapamil and the specific risk factors for this malignant treatment course.