頑固性癲癇重積狀態（RSE, refractory status epilepticus）是會致命的醫療急症，為了減少不可逆的神經傷害，需要積極給予藥物治療。而肝臟是許多抗癲癇藥物代謝與排出體外的主要器官，因此對於藥物引起的毒性會更加敏感，所以當頑固性癲癇重積狀態患者合併肝功能不佳時，使用抗癲癇藥物更應特別謹慎。
患者為一名年紀3歲6個月大的男孩，因被懷疑是腦膜腦炎而轉至高雄某醫學中心兒科加護病房，給予diazepam, phenytoin, phenobarbital, midazolam後，癲癇發作仍持續，因此使用thiopental以產生burst suppression coma，但患者血壓下降至60/30 mmHg，隔天GOT（glutamic-oxaloacetic transaminase）和GPT（glutamic-pyruvic transaminase）急遽竄升到2990和1156 IU/L，因無法排除藥物造成肝毒性的可能，醫師緊急停用phenytoin、減少phenobarbital和thiopental的劑量，患者肝指數逐漸恢復，但SE（status epilepticus）仍未穩定控制，發生心室顫動和心跳停止，經施行緊急心肺復甦術後，生命跡象恢復穩定。經過數次調整用藥，其癲癇發作頻率減少且並無任何肝功能異常。之後，因整體癲癇發作狀況大致獲得控制，該名患者遂轉至普通病房。

Refractory status epilepticus (RSE) is a life-threatening medical emergency. Prompt and aggressive pharmacologic management is paramount in order to decrease the irreversible neuronal injury. Liver is the primary organ for metabolism and elimination of many antiepileptic drugs (AEDs), thus it is particularly vulnerable to drug-induced toxicity. Therefore, it is a challenge for clinical practician to choose the appropriate AEDs in RSE children with hepatic complications.
A 3 years 6 months old boy was transferred to pediatric intensive care unit under the impression of meningoencephalitis. After giving diazepam, phenytoin, phenobarbital and midazolam, his seizure still persisted so we start thiopental to induce burst suppression coma. However, the blood pressures dropped drown and the GOT (Glutamic-oxaloacetic transaminase)/GPT (Glutamic-pyruvic transaminase) increased to 2990/1156 IU/L, we hold phenytoin, decreased the doses of phenobarbital and thiopental for avoiding the severe liver toxicity. The hepatic enzyme levels return to normal range but ventricular fibrillation and asystole symptom occurred. After emergent cardiopulmonary resuscitation, his vital signs got stable. Finally, his seizure frequency decreased without hepatic function impairment after several times of adjustment anticonvulsants, then he was transferred to general ward.