Updates in Refractory Status Epilepticus

Abstract

Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. New-onset refractory status epilepticus (NORSE) is a recently coined term for refractory status epilepticus where no apparent cause is found after initial testing. A large proportion of NORSE cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment. Management of refractory status epilepticus involves treatment of an underlying etiology in addition to intravenous anesthetics and antiepileptic drugs. Alternative treatment options including diet therapies, electroconvulsive therapy, and surgical resection in case of a focal lesion should be considered. Short-term and long-term outcomes tend to be poor with significant morbidity and mortality with only one-third of patients reaching baseline neurological status.

A Rare Case of Refractory Status Epilepticus Recurring in the Second and Third Trimesters of Pregnancy

“…Management of RSE involves the treatment of underlying etiology in addition to IV anesthetics and antiepileptic drugs. 3 One of the most important cause of epileptic seizures in pregnancy is the abrupt cessation of antiepileptic drug (AED) therapy by the pregnant woman. 10 In our patient, the laboratory tests and intracranial imaging techniques did not show any pathology.…”

“…Approximately one third of RSE cases return to the initial neurological status, while most cases have severe morbidities including short-term and longterm neurological problems. 3 Generalized convulsive SE is accompanied by a marked increase in endogenous catecholamine release. This may result in arterial hypertension, potential lethal tachyarrhythmia, pulmonary edema requiring mechanic ventilation, renal damage, and disseminated intravascular coagulation.…”

“…2 The incidence of SE is around 12.6/100.000. 3 Refractory status epilepticus (RSE) is defined as persistent seizures despite the use of two intravenous (IV) antiepileptics including benzodiazepine. IV anesthetic agents are used in the treatment of RSE.…”

“…Midazolam is commonly used for the treatment of RSE. 3 Approximately 31-43% of SE episodes progress to the refractor status. 2 Status epilepticus in pregnancy is very rare, and there are only a few reported cases of RSE during pregnancy.…”

Status epilepticus im Kindes- und Jugendalter – ein oft unterschätztes Notfallereignis

“…Die DGN empfiehlt mittlerweile Levetiracetam als nächstes Medikament nach Erfolglosigkeit des primären Benzodiazepins. Ein großer Vorteil ist, dass es sowohl bei fokalen als auch generalisierten Anfällen wirkt, nur eine minimale Proteinbindung und keinen hepatischen Metabolismus hat [19]. Empfohlen wird die Injektion von 30-60 mg/kg KG mit maximal 500 mg/min.…”