PMC9619166_01
Graphical representation of IV to enteric ganaxolone for Patient #1. For our first patient, GNX was administered via protocol using an IV bolus, followed by infusion over 4 days (with GNX boluses as needed for breakthrough seizures) followed by a taper on day 5 and transition to enteric maintenance GNX. On day 1, pentobarbital was discontinued; by day 3, clinical and electrographic seizures stopped.
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As anesthesia was weaned on a third attempt and seizures returned while on the same antiseizure medication regimen, GNX was initiated on hospital day 17 using an IV bolus, followed by infusion over 4.5 days (with boluses as needed for breakthrough seizures followed by a taper and transition to enteric maintenance on day 5 (Fig. 1b).
Graphical representation of IV to enteric ganaxolone for Patient #2. For our second patient GNX was initiated while she remained on two continuous IV infusions: midazolam and ketamine. GNX was initiated on hospital day 17 using an IV bolus, followed by infusion over 4.5 days (with boluses as needed for breakthrough seizures followed by a taper and transition to enteric maintenance on day 5. Midazolam was discontinued by day 2 of IV GNX protocol; ketamine was discontinued by day 8 with the assistance of phenobarbital loads and maintenance for breakthrough seizures.
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On day 1, pentobarbital was discontinued; by day 3, clinical and electrographic seizures stopped (Fig. 2).
PMC9619166_02
Graphical representation of IV to enteric ganaxolone for Patient #1. For our first patient, GNX was administered via protocol using an IV bolus, followed by infusion over 4 days (with GNX boluses as needed for breakthrough seizures) followed by a taper on day 5 and transition to enteric maintenance GNX. On day 1, pentobarbital was discontinued; by day 3, clinical and electrographic seizures stopped.
gr1a.jpg
PMC9619166_02_gr1a.jpg
f0005
As anesthesia was weaned on a third attempt and seizures returned while on the same antiseizure medication regimen, GNX was initiated on hospital day 17 using an IV bolus, followed by infusion over 4.5 days (with boluses as needed for breakthrough seizures followed by a taper and transition to enteric maintenance on day 5 (Fig. 1b).
EEG during ganaxolone infusion for Patient # 1. Day 1 of Ganaxolone Infusion, Patient # 1. Anterior-posterior longitudinal bipolar montage (a.k.a. "Double Banana") b. Day 5 of Ganaxolone Infusion, Patient # 1. Double Banana montage.
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Seizure cessation was gradual and achieved by day 8 (Fig. 3).