The treatment of super refractory status epilepticus oxford academic the treatment of super refractory status epilepticus. Resistance to benzodiazepine and barbiturate treatment for this disorder is thought to be due to internalization of synaptic. Superrefractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency. The outcome of patients with refractory and super refractory status epilepticus srse is variable. Sethi seeks the authors recommendation regarding which patients with norse should be treated immediately with. Refractory status epilepticus rse has been defined variably in the literature as seizures that do not respond to 2 14 or 3 58 different antiepileptic medications, usually intravenous benzodiazepines as a firstline agent and intravenous phenytoin, phenobarbital, or valproic acid as a secondline agent. Early recognition and initiation of treatment leads to a better response and may improve outcomes.
Refractory status epilepticus rse is continued seizures after the failure of two or more aeds. Febrile status epilepticus cases are often associated with inflammatory neurological diseases caused by specific pathogens or antineuronal autoimmunity. At present, magnetic resonance imaging mri studies that evaluate brain atrophy in srse are lacking. Seizures refractory to thirdline therapy are also labeled super refractory status epilepticus srse. Listing a study does not mean it has been evaluated by the u. Newonset refractory status epilepticus norse is a recently coined term for refractory status epilepticus where no. The success rate of each of the following agents, ketamine, inhaled. In the absence of established guidelines, the treatment of super refractory status epilepticus. Refractory to two antiepileptic agents and general anesthesia treatment for 24 hours. In the article, new onset refractory status epilepticus research. Super refractory status epilepticus srse is a devastating neurological condition with limited treatment options.
Purposein view of paucity of studies on srse, we report the frequency, etiology and outcome of srse. Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. Efficacy of ketamine in refractory convulsive status. Author links open overlay panel alejandra vasquez a raquel fariasmoeller b william. Status epilepticus is one of the most common neurological emergencies in children and adults. Refractory status epilepticus is defined as recurrent seizure. We conducted an extensive literature search to identify and summarize the therapeutic options for srse. Pdf consensus protocol for the treatment of superrefractory. Sketamine in refractory and superrefractory status. A study with sage547 for superrefractory status epilepticus. Treatment of refractory and superrefractory status. He failed to respond to treatment with high doses of intravenous valproic acid, levetiracetam, lacosamide, thiopental, and midazolam. Oral perampanel for the treatment of superrefractory. The search mainly resulted in case reports of various pharmacologic and nonpharmacologic treatments.
Super refractory status epilepticus is named for those continuous unabated,prolonged seizure activity, despite aggressive treatment including general anesthesia, lasting more than 24 hours. Pediatric refractory and superrefractory status epilepticus. The ketogenic diet for paediatric patients with superrefractory status. Superrefractory status epilepticus explained youtube. The treatment and prognosis of refractory and super. Intrathecal overproduction of proinflammatory cytokines. Evaluate therapeutic strategies for super refractory status epilepticus.
Treatment of refractory and super refractory status epilepticus. Evaluate factors that may affect treatment success in patients with status epilepticus. Is pentobarbital safe and efficacious in the treatment of. Refractory to first and secondline antiepileptic agents. The seizures can be of the tonicclonic type, with a regular pattern of contraction and extension of the arms and legs, or of types that do not involve contractions. Electroconvulsive therapy for refractory status epilepticus. The following is supplementary data to this article. To describe a case series of adult patients in the intensive care unit in superrefractory status epilepticus srse. Newonset refractory status epilepticus genetic and rare. In addition, there is a subgroup of super refractory status epilepticus triggered by fever and having no known cause. Plasmapheresis for refractory status epilepticus, part i. It includes cases where status epilepticus recurs on reduction or withdrawal of anaesthesia. We aimed to investigate the values of neuroimaging and continuous electroencephalogram eeg in the multimodal prediction.
A 72yearold man presented with a super refractory partial status epilepticus following evacuation of a right subdural hematoma. Evaluate therapeutic strategies for superrefractory status epilepticus. These seizures are extremely difficult to control and associated with poor outcome. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. Several recent guidelines and consensus statements highlight the critical role of continuous eeg ceeg monitoring during prolonged treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for rcse, which. There is ongoing serious damage to the neuraxis, in such cases, if seizures continue. Super refractory status epilepticus srse, or seizures continuing for 24 hours despite general anesthesia, is a neurologic emergency with high morbidity and mortality. How refractory is superrefractory status epilepticus a. Generalized convulsive status epilepticus emcrit project. Srse, though infrequently seen, constitutes a medical emergency due to the associated high morbidity. The term super refractory status epilepticus srse refers to a re fractory episode continuing under general anesthesia for more than 24 h. It is an uncommon but important clinical problem with a high mortality and morbidity. Superrefractory status epilepticus pdf free download.
Superrefractory status epilepticus is a lifethreatening condition. Status epilepticus that cannot be controlled with first and secondline agents is called refractory status epilepticus rse, a condition that is associated with significant morbidity and mortality. Pediatric superrefractory status epilepticus treated with. The treatment of superrefractory status epilepticus. Ketogenic diet for adults in superrefractory status. Diazepam agegender seizure etiology aeds usedconcurrent. Super refractory status epilepticus the scale of the problem although relatively rare they are increasingly seen in specialised neurointensive care units and may take up bed space for many months morbidity and mortality is high due to the general complications of icu recovery is variable and therefore discussions regarding futility. Most experts agree that treatment of rse necessitates the use of continuous infusion intravenous anesthetic drugs such as midazolam, propofol, pentobarbital, thiopental, and ketamine, each of. Backgroundsuper refractory status epilepticus srse is an important and recently recognized neurological emergency. Pdf refractory and superrefractory status epilepticusan update. Predictors of outcome in refractory status epilepticus.
Andrew cole, md of massachusetts general hospital and harvard medical school explains superrefractory status epilepticus. A status epilepticus which persists for 24 hours or more after starting treatment with anaesthesia or has recurred inspite of general anesthesia is known as super refractory status epilepticus srse. Treatment of refractory and superrefractory status epilepticus. The definition of rse was as per the neurocritical care society guidelines on. Frontiers a study of super refractory status epilepticus. Common intravenous agents such as diazepam, lorazepam, midazolam, and phenytoin used to treat rse have frequent problems with toxicity or efficacy 35. Distinguish gaps in the literature related to optimal status epilepticus treatment. Management of superrefractory status epilepticus with. Lacosamide for refractory pediatric status epilepticus.
We aimed to characterize efficacy and sideeffects of continuous infusions of pentobarbital civptb treating srse. Brain atrophy in superrefractory status epilepticus jama. Superrefractory status epilepticus srse is defined as status epilepticus that continues or recurs 24 hours or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anaesthesia. Super refractory status epilepticus is defined as status epilepticus that continues or recurs 24 h or more after the onset of anaesthetic therapy, including those cases where status epilepticus. We conducted a multicenter, phase 12 study in srse patients to evaluate the safety and tolerability of brexanolone usan. Superrefractory status epilepticus srse is defined as an epileptic status that continues or recurs 24 h or more after the initiation of anaesthetic. Guidelines for the evaluation and management of status epilepticus. Seizure reductioncontrol with the application of ect occurred in 11 of the 19. Srse is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, including those cases in which the. Etiologies and characteristics of refractory status epilepticus cases in different areas of the world. In contrast with the initial phases of status epilepticus, treatment lacks strong. Importance prolonged seizures in superrefractory status epilepticus srse have been shown to cause neuronal death and reorganization, and visual inspection in individual case studies has demonstrated progressive cortical and subcortical atrophy. A study with sage547 for superrefractory status epilepticus the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Guidelines for the evaluation and management of status.
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