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Medical-related question for my science-fiction story.

My character is in a facility with modern BUT limited medical supplies. This character is suffering from seizures due to withdrawal from a certain substance, and the doctor present has fruitlessly attempted to stop the seizures (using some form of benzodiazepine).

So, my question: I know that a last ditch effort for stopping seizures is a medically-induced coma. But in order to move my story along, I'd need my character conscious during this time. The facility DOES have sedatives, so it seems like a doctor would just put him under -- and sabotage my plot point! The only out I can think of is that the optimal drugs for knocking out a seizure victim aren't present in this facility. But would this really cause a doctor to hesitate sedating the patient? I'm not a doctor, so I don't know what the reasonable call would be.

Any sort of reality check would be appreciated!

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    $\begingroup$ I googled around it doesn't seem like sedatives are used to control seizures, it's not clear to me if sedation would do anything. There are drugs specifically for controlling seizures such as lorazepam or phenytoin that are used. Would your facility have something like those? $\endgroup$
    – user72572
    Commented Feb 19, 2020 at 1:06
  • $\begingroup$ Thanks for the comment :-) And yes, lorazepam would be used, but it wouldn't work (in my story, that is). The internet has kind of been my main source of info too...and I've read that certain drugs can be used to put the patient into a comatose state for some relief. But just not sure if having the improper sedative would pose enough risk to skip that altogether. Confusing haha! $\endgroup$
    – cal
    Commented Feb 19, 2020 at 1:23
  • $\begingroup$ It would heavily depend on what the drug being withdrawn from is and what's it's mechanism of action. Without that info, we're likely to only come up with standard procedures. Perhaps you should tell us what you want the drug to do and how it works - else ask a question to establish these things. $\endgroup$
    – Escaped dental patient.
    Commented Feb 19, 2020 at 4:37

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Here is a good algorithm for status epileptics = uncontrolled seizures.

https://emcrit.org/pulmcrit/status-epilepticus-2/

enter image description here

The author is of the opinion that a lot of the bad effects from continued seizures has to do with the body moving. A way to stop the body moving is to paralyze a person with drugs. The body stops moving but the person then cannot breathe (because respiratory muscles are paralyzed), so you need a mechanical ventilator. It is unpleasant to be awake while paralyzed because it is scary, and so they sedate with propofol. Propofol will knock you out but good.

Your doc does not have seizure meds or what he has does not work fast enough. He paralyzes and sedates the patient and puts him on a ventilator while they send for different / better drugs.

If you don't want him to use propofol you can just have the seizing guy be paralyzed and on the ventilator. If he is having seizures that bad he probably won't be awake enough to be scared.

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    $\begingroup$ I remember reading that small amounts of fugu fish poison (aka tetrodotoxin, which is isn't a sedative, but rather a paralytic agent) was used in ancient Japan to treat seizures, so that seems to be in favor of the idea. Of course, tetrodotoxin itself isn't a good idea because it's lethal, but it's the principle of the matter. $\endgroup$
    – Halfthawed
    Commented Feb 19, 2020 at 2:00
  • $\begingroup$ So, in the absence of a ventilator, would paralyzing be out of the question? In case you haven't noticed, I'm really just trying to create problems for my fictitious doctor -- poor guy. $\endgroup$
    – cal
    Commented Feb 19, 2020 at 2:28
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    $\begingroup$ There was an accident where the hospital pharmacy confused an antibioitc with a paralytic. 4 people died but the fifth was in the surgery recovery area and they noticed he had stopped breathing. They used an ambu-bag to breathe for him while they got the ventilator arranged and he lived. You could have your doc bag him while paralyzed. $\endgroup$
    – Willk
    Commented Feb 19, 2020 at 3:34

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