Super-Refractory Status Epilepticus: Prognosis and Recent Advances in Management

Abstract

Super-refractory status epilepticus (SRSE) is a life-threatening neurological emergency with high morbidity and mortality. It is defined as "status epilepticus (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 withdrawal of anesthesia." This condition is resistant to normal protocols used in the treatment of status epilepticus and exposes patients to increased risks of neuronal death, neuronal injury, and disruption of neuronal networks if not treated in a timely manner. It is mainly seen in patients with severe acute onset brain injury or presentation of new-onset refractory status epilepticus (NORSE). The mortality, neurological deficits, and functional impairments are significant depending on the duration of status epilepticus and the resultant brain damage. Research is underway to find the cure for this devastating neurological condition. In this review, we will discuss the wide range of therapies used in the management of SRSE, provide suggestions regarding its treatment, and comment on future directions. The therapies evaluated include traditional and alternative anesthetic agents with antiepileptic agents. The other emerging therapies include hypothermia, steroids, immunosuppressive agents, electrical and magnetic stimulation therapies, emergent respective epilepsy surgery, the ketogenic diet, pyridoxine infusion, cerebrospinal fluid drainage, and magnesium infusion. To date, there is a lack of robust published data regarding the safety and effectiveness of various therapies, and there continues to be a need for large randomized multicenter trials comparing newer therapies to treat this refractory condition.

Ketamine in adult super‐refractory status epilepticus: Efficacy analysis on a prospective registry

“…These entities bear an increasing mortality risk, up to 40%, depending on underlying patient characteristics, SE etiologies, history of seizures, and treatment regimen 3‐5 . High mortality has been reported when SE results from acute brain injury, such as stroke, infection, 6 or inflammatory conditions, 7 and severe, progressive entities, such as malignant brain tumors.…”

Factors affecting prognosis of status epilepticus among patients presenting to a tertiary care hospital

“…The need of the hour is to prevent super-refractory status epilepticus by controlling the risk factors in the population, as mortality rate in these cases ranges from 30 to 50%. 24 …”

“…The need of the hour is to prevent super-refractory status epilepticus by controlling the risk factors in the population, as mortality rate in these cases ranges from 30 to 50%. 24 Limitations of the study: This was a retrospective study confined to one tertiary care hospital. Moreover, our set-up lacks the resources for continuous EEG monitoring of patients under ICU care.…”

Animal Models of Epilepsy: A Phenotype-oriented Review

“…Status epilepticus (SE) is a severe emergency, carrying neuronal injury, abnormal neuronal networks and high mortality[ 76 ].Common SE models originate from electrical kindling and chemical kindling models [ 77 ]. SE can be induced via electrical stimulus in rat models with an electrode implanted into the amygdala or hippocampus [ 10 ].…”