Status Epilepticus and Beyond: A Clinical Review of Status Epilepticus and an Update on Current Management Strategies in Super-refractory Status Epilepticus

Abstract

Status epilepticus and refractory status epilepticus represent some of the most complex conditions encountered in the neurological intensive care unit. Challenges in management are common as treatment options become limited and prolonged hospital courses are accompanied by complications and worsening patient outcomes. Antiepileptic drug treatments have become increasingly complex. Rational polytherapy should consider the pharmacodynamics and kinetics of medications. When seizures cannot be controlled with medical therapy, alternative treatments, including early surgical evaluation can be considered; however, evidence is limited. This review provides a brief overview of status epilepticus, and a recent update on the management of refractory status epilepticus based on evidence from the literature, evidence-based guidelines, and experiences at our institution.

Clinico-Etiological Profile of Pediatric Refractory Status Epilepticus at a Public Hospital in India

“…SE was defined as a seizure lasting longer than 30 minutes, or recurrent seizures that lasted more than 30 minutes, during which the patient did not regain consciousness 11. RSE was defined as seizures that persisted despite the administration of two appropriate anticonvulsants at acceptable doses 4,5. Outcomes were assessed based on the Glasgow Outcome Scale (GOS),12 and were applied when the patient left the hospital, whether discharged or left against medical advice (LAMA).…”

“…Refractory status epilepticus (RSE) is a more severe variant of SE, and was previously defined based on duration (i.e., when SE persisted for more than 1 or 2 hours) 4. Presently, the most widely-accepted definition considers RSE to occur when seizures persist despite the administration of two appropriate anticonvulsants at acceptable doses,4 and is estimated to occur in around 10–40% of patients with SE 4,5. RSE has been shown to be associated with higher mortality and more neurological sequelae 6…”

Correlation of serum S100B levels with brain magnetic resonance imaging abnormalities in children with status epilepticus

“…The SE groups consisted of all children with a history of SE that met the following criteria: (1) aged 1 month up to 18 years, (2) first experience of SE, (3) obtained parental consent indicated by filling out the written informed consent. SE characterized as any seizure lasting 30 minutes or more or intermittent seizures lasting for more than 30 minutes without recovery of consciousness interictally [2]. They were excluded if there were history of head trauma and congenital abnormalities.…”

“…Status epilepticus (SE) is neurological events causing significant morbidity and mortality in children [1]. Early definitions of SE described seizures persisting “for a sufficient length of time or is repeated frequently enough to produce a fixed or enduring epileptic condition [2]. In recent years, many studies have been conducted on biomarkers in biological fluids that correlate with neurological disorders, for example, neuron-specific enolase or Tau protein [3].…”

Use of levetiracetam in pediatric refractory status epilepticus

“…Although, after initial benzodiazepines, phenytoin and valproate are used as standard second-line therapy in the control of SE in children [18][19][20][21] , I/V LEV should be considered as an effective and safe alternative treatment, prior to use of general anesthtics for the control of refractory SE in children 15,22 . Our experience with the present case has supported this option.…”