Refractory status epilepticus

Abstract

Status epilepticus (SE) is a frequent neurological emergency with an annual incidence of 10-20/100,000 individuals. The overall mortality is about 10-20%. Patients present with long-lasting fits or series of epileptic seizures or extended stupor and coma. Furthermore, patients with SE can suffer from a number of systemic complications possibly also due to side effects of the medical treatment. In the beginning, standardized treatment algorithms can successfully stop most SE. A minority of SE cases prove however to be refractory against the initial treatment and require intensified pharmacologic intervention with nonsedating anticonvulsive drugs or anesthetics. In some partial SE, nonpharmacological approaches (e.g., epilepsy surgery) have been used successfully. This paper reviews scientific evidence of the diagnostic approach, therapeutic options, and course of refractory SE, including nonpharmacological treatment.

Making SENSE - Sustained Effort Network for treatment of Status Epilepticus as a multicenter prospective registry

“…The International League Against Epilepsy (ILAE) classification for seizures [ 1 ] (Commission on Classification and Terminology of the International League Against Epilepsy 1981) defines SE as a seizure that persists ‘for a sufficient length of time or is repeated frequently enough that recovery between attacks does not occur’. Several authors operationalize the term ‘sufficient length of time’ as 30 min [ 2 ]. However, almost all generalized tonic-clonic seizures last less than 5 min, and most focal (complex partial or simple partial) seizures last less than 10 min [ 3 , 4 ].…”