Super‐refractory status epilepticus: An approach to therapy in this difficult clinical situation

Abstract

SUMMARYSuper-refractory status epilepticus (SE) is a stage of refractory SE characterized by unresponsiveness to initial anesthetic therapy. It is a new concept that has been the focus of recent basic and therapeutic work, and is defined as ''SE that continues or recurs 24 hours or more after the onset of anesthesia, including those cases in which SE recurs on the reduction or withdrawl of anesthesia.'' It is encountered typically, but not exclusively, in two quite distinctive clinical situations: (1) in patients with severe acute brain injury, and (2) in patients with no history of epilepsy in whom status epilepticus develops out of the blue with no overt cause. There are a variety of treatments used, almost entirely based on open observational studies or case reports. Therapy includes anesthesia, antiepileptic drug therapy, hypothermia and ICU therapy, other medical, immunological, and physical therapies. In this review, the range of possible therapies is outlined and an approach to therapy is discussed.

Actualización en el manejo del estado epiléptico.

“…El estado epiléptico super-refractario es el EE que continúa o recurre 24 horas o más luego del inicio de la terapia anestésica, incluyéndose los casos que recurren cuando se está reduciendo o retirando el anestésico (27). Se estima que un 15% de todos los casos con EE admitidos al hospital llegan a un EE super-refractario, con una mortalidad que alcanza el 30 a 50%; es por ello que, siendo ésta una condición seria, se recomienda identificar la causa.…”

Super-refractory Status Epilepticus: An atypical presentation and case-based review

“…[1,2] It is a severe variant of refractory status epilepticus which is defined as continuous or repetitive seizures lasting longer than 60 minutes despite treatment with a benzodiazepine together with any other standard anticonvulsant (usually phenytoin/fosphenytoin) in adequate loading dose. [1,3] It is a fairly uncommon clinical problem with high morbidity and mortality rates of up to 30% to 50%, and occurs in 10-15% of patients with status epilepticus presenting at the hospital. [2,4] Various pharmacological treatment schemes have been proposed.…”

“…[2,4] Various pharmacological treatment schemes have been proposed. [1,[5][6][7] Most of these treatment modalities are based on either observational studies or case reports. [1,5] The longer the duration of status epilepticus, the higher the risk of progression to refractory or even to super-refractory status epilepticus which may result in either death or a debilitating sequelae.…”

“…[1,[5][6][7] Most of these treatment modalities are based on either observational studies or case reports. [1,5] The longer the duration of status epilepticus, the higher the risk of progression to refractory or even to super-refractory status epilepticus which may result in either death or a debilitating sequelae. [2,3,8,9] In addition, female gender and acute underlying causes including acute infections of the central nervous system have both been identified as strong factors for developing refractory illness.…”

“…[10][11][12][13] Super-refractory status epilepticus is typically encountered, though not exclusively, in two quite distinctive clinical situations. [1] First, it occurs in patients with severe acute brain injury or infection, and in patients with no history of epilepsy in whom status epilepticus (SE) develops from no overt cause. [1] This latter situation has been considered by some to be a "syndrome" referred to as NORSE (new-onset refractory status epilepticus).…”