Treatment of Super-Refractory Status Epilepticus: A Review

Ochoa, Juan G.; Dougherty, Michelle; Papanastassiou, Alex M.; Gidal, Barry E.; Mohamed, Ismail; Vossler, David G.

doi:10.1177/1535759721999670

Cited by 25 publications

(23 citation statements)

References 91 publications

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“…Super-refractory SE is defined as seizure activity >24 h despite treatment with anesthetic agents. This includes cases in which seizures recur with an attempted withdrawal of the anesthetics ( 76 ). Effective treatment of SE is critical as morbidity and mortality increase dramatically the longer convulsive SE persists.…”

Section: Epilepsy In Dogsmentioning

confidence: 99%

Dogs as a Natural Animal Model of Epilepsy

Löscher

2022

Front. Vet. Sci.

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Epilepsy is a common neurological disease in both humans and domestic dogs, making dogs an ideal translational model of epilepsy. In both species, epilepsy is a complex brain disease characterized by an enduring predisposition to generate spontaneous recurrent epileptic seizures. Furthermore, as in humans, status epilepticus is one of the more common neurological emergencies in dogs with epilepsy. In both species, epilepsy is not a single disease but a group of disorders characterized by a broad array of clinical signs, age of onset, and underlying causes. Brain imaging suggests that the limbic system, including the hippocampus and cingulate gyrus, is often affected in canine epilepsy, which could explain the high incidence of comorbid behavioral problems such as anxiety and cognitive alterations. Resistance to antiseizure medications is a significant problem in both canine and human epilepsy, so dogs can be used to study mechanisms of drug resistance and develop novel therapeutic strategies to benefit both species. Importantly, dogs are large enough to accommodate intracranial EEG and responsive neurostimulation devices designed for humans. Studies in epileptic dogs with such devices have reported ictal and interictal events that are remarkably similar to those occurring in human epilepsy. Continuous (24/7) EEG recordings in a select group of epileptic dogs for >1 year have provided a rich dataset of unprecedented length for studying seizure periodicities and developing new methods for seizure forecasting. The data presented in this review substantiate that canine epilepsy is an excellent translational model for several facets of epilepsy research. Furthermore, several techniques of inducing seizures in laboratory dogs are discussed as related to therapeutic advances. Importantly, the development of vagus nerve stimulation as a novel therapy for drug-resistant epilepsy in people was based on a series of studies in dogs with induced seizures. Dogs with naturally occurring or induced seizures provide excellent large-animal models to bridge the translational gap between rodents and humans in the development of novel therapies. Furthermore, because the dog is not only a preclinical species for human medicine but also a potential patient and pet, research on this species serves both veterinary and human medicine.

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Section: Epilepsy In Dogsmentioning

confidence: 99%

Dogs as a Natural Animal Model of Epilepsy

Löscher

2022

Front. Vet. Sci.

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“…29,30 The clinical evidence is good for the earlier treatment stages, but refractory status epilepticus and super-refractory status epilepticus can still be considered an "evidence-free area." 31 This article does not follow the traditional scholarly approach but instead reviews status epilepticus as a process, spanning from the initial onset of symptoms to the application of continuous EEG in the neurologic intensive care unit (FIGURE 12-2). After some introductory information on definitions, classifications, epidemiology, and treatment principles, the article follows a patient's pathway through the treatment stages and focuses on the practicalities, supported by scientific evidence wherever possible.…”

Section: Minutes 30 Minutesmentioning

confidence: 99%

“…The clinical evidence is good for the earlier treatment stages, but refractory status epilepticus and super-refractory status epilepticus can still be considered an “evidence-free area.” 31 …”

Section: Introductionmentioning

confidence: 99%

Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus

Trinka¹,

Leitinger²

2022

CONTINUUM: Lifelong Learning in Neurology

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PURPOSE OF REVIEW: Status epilepticus is a serious condition caused by disorders and diseases that affect the central nervous system. In status epilepticus, hypersynchronous epileptic activity lasts longer than the usual duration of isolated self-limited seizures (time t1), which causes neuronal damage or alteration of neuronal networks at a certain time point (time t2), depending on the type of and duration of status epilepticus. The successful management of status epilepticus includes both the early termination of seizure activity and the earliest possible identification of a causative etiology, which may require independent acute treatment. In nonconvulsive status epilepticus, patients present only with subtle clinical signs or even without any visible clinical manifestations. In these cases, EEG allows for the assessment of cerebral function and identification of patterns in need of urgent treatment.RECENT FINDINGS: In 2015, the International League Against Epilepsy proposed a new definition and classification of status epilepticus, encompassing four axes: symptomatology, etiology, EEG, and age. Various validation studies determined the practical usefulness of EEG criteria to identify nonconvulsive status epilepticus. The American Clinical Neurophysiology Society has incorporated these criteria into their most recent critical care EEG terminology in 2021. Etiology, age, symptomatology, and the metabolic demand associated with an increasing duration of status epilepticus are the most important determinants of prognosis. The consequences of status epilepticus can be visualized in vivo by MRI studies. SUMMARY: The current knowledge about status epilepticus allows for a more reliable diagnosis, earlier treatment, and improved cerebral imaging of its consequences. Outcome prediction is a soft tool for estimating the need for intensive care resources. UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE:Drs Trinka and Leitinger discuss the unlabeled/investigational use of antiseizure medications for the treatment of status epilepticus.

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“…[1][2][3]8] Further, when SE continues despite general anesthetic treatment for RSE over 24 h, it is called "SRSE. " [2,3,6,9,10,12,15] It has been reported that 24-48% of SE progresses to RSE and 15%-22% of RSE progresses to SRSE. [2,15] SRSE is recognized as a neurological emergency disease that is difficult to treat and has a poor prognosis, with death occurring in 35% of cases and 13% suffering from serious neurological sequelae.…”

Section: Introductionmentioning

confidence: 99%

Good seizure outcome after focal resection surgery for super-refractory status epilepticus: Report of two cases

Yonamoto

Mukae

Shimogawa

et al. 2022

Surgical Neurology International

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Background: There is scarce evidence regarding focal resection surgery for super-refractory status epilepticus (SRSE), which is resistant to general anesthetic treatment over 24 h. We report two patients with SRSE, in whom good seizure outcomes were obtained following focal resection surgery. Case Description: Patient 1: A 58-year-old man who underwent left anterior temporal lobectomy with hippocampectomy at the age of 38 years after being diagnosed left medial temporal lobe epilepsy. After 19 years of surgery with no epileptic attacks, the patient developed SRSE. Electroencephalogram (EEG) demonstrated persistence of lateralized periodic discharges in the left frontotemporal region. On the 20th day after SRSE onset, resection of the frontal lobe and temporal lobe posterior to the resection cavity was performed. Patient 2: A 62-year-old man underwent craniotomy for anaplastic astrocytoma in the left frontal lobe at the age of 34 years. Since the age of 60 years, he developed SRSE 3 times over 1 and 1/12 years. On EEG, repeated ictal discharges were observed at the medial part of the left frontal region during the three SRSEs. Corresponding to the ictal EEG findings, high signals on diffusion-weighted magnetic resonance images and focal hypermetabolism on fluorodeoxyglucose-positron emission tomography were observed around the supplementary motor area, medial to the resection cavity. Resection surgery of the area was performed during the interictal period. Conclusion: Good seizure outcome was obtained in the two cases which provide additional support for the recent concept of focal resection surgery as an indication for SRSE.

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Treatment of Super-Refractory Status Epilepticus: A Review

Cited by 25 publications

References 91 publications

Dogs as a Natural Animal Model of Epilepsy

Dogs as a Natural Animal Model of Epilepsy

Management of Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus

Good seizure outcome after focal resection surgery for super-refractory status epilepticus: Report of two cases

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