Management of super refractory status epilepticus

Super refractory status epilepticus ( SRSE ) is the status epilepticus in which the seizures continue for 24 hour or more after anesthetic medications to control and reappear when the patient is weaned from the anesthetic agent. Characteristic seizures are distinguished, by the presence and/or absence of motor seizure, into convulsive and non-convulsive status epilepticus (NCSE). An aggressive therapy is often needed after diagnosis is confirmed. Continuous monitoring during therapy is very important. The management for SRSE includes pharmacological and non-pharmacological treatment. Clinical and electrographic seizure suppression is the treatment goal. After that we need to find and treat the cause of seizures. Clinical judgement by the clinician is needed to identify the risks of excessive suppression of the nervous system, so as the morbidity and mortality is reduced for those patients who can survive but often have difficult and prolonged recovery. Received: 24 Oct 2018Reviewed: 28 Oct 2018Accepted: 6 Nov 2018 Citation: Kurniawan D, Machin A, Hidayati HB, Islamiyah WR. Management of super refractory status epilepticus. Anaesth Pain & Intensiv Care 2018;22 Suppl 1:S67-S72

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Not all patients with convulsive status epilepticus intubated in pre-hospital settings meet the criteria for refractory status epilepticus

Seizure ◽

10.1016/j.seizure.2021.03.015 ◽

2021 ◽

Vol 88 ◽

pp. 29-35

Author(s):

Sinead Zeidan ◽

Benjamin Rohaut ◽

Hervé Outin ◽

Francis Bolgert ◽

Marion Houot ◽

...

Keyword(s):

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Convulsive Status Epilepticus ◽

Refractory Status

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Enteral Topiramate in a Pediatric Patient with Refractory Status Epilepticus: A Case Report and Review of the Literature

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.4.317 ◽

2014 ◽

Vol 19 (4) ◽

pp. 317-324

Author(s):

Chasity M. Shelton ◽

Elizabeth L. Alford ◽

Stephanie Storgion ◽

James Wheless ◽

Stephanie J. Phelps

Keyword(s):

Case Report ◽

Metabolic Acidosis ◽

Status Epilepticus ◽

Pediatric Patient ◽

Treatment Option ◽

Refractory Status Epilepticus ◽

Convulsive Status Epilepticus ◽

Review Of The Literature ◽

Refractory Status

We describe the use of topiramate in a healthy 12-year-old (88-kg) male who developed refractory generalized convulsive status epilepticus. Seizures persisted despite aggressive use of benzodiazepines (intravenous lorazepam; oral clorazepate), barbiturates (i.e., phenobarbital, pentobarbital), and hydantoins. The child's seizures were controlled with nasogastrically administered topiramate in doses up to 500 mg twice daily (11.4 mg/kg/day). The patient did not display any clinical or laboratory signs of metabolic acidosis while receiving topiramate. Topiramate should be considered as a treatment option in refractory status epilepticus.

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Antiepileptic Drugs

10.1093/med/9780190684747.003.0006 ◽

2018 ◽

Author(s):

Eelco F. M. Wijdicks ◽

Sarah L. Clark

Keyword(s):

Intensive Care Unit ◽

Decision Making ◽

Intensive Care ◽

Status Epilepticus ◽

Antiepileptic Drugs ◽

Refractory Status Epilepticus ◽

Convulsive Status Epilepticus ◽

Refractory Status ◽

Focal Status Epilepticus

Patients are often admitted to the neurosciences intensive care unit specifically for the treatment of a series of seizures or focal status epilepticus. Far more urgent is convulsive status epilepticus, which requires multiple intravenously administered antiepileptic drugs. The choices are different when the patient is in status epilepticus and refractoriness is mostly due to pharmacologic resistance. Use of an algorithm for decision making is common in the management of refractory status epilepticus. Antiepileptic drugs often interact with other antiepileptic drugs. This chapter discusses the use of antiepileptic drugs available to treat seizures, recurrent seizures, status epilepticus, and refractory status epilepticus.

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Spectrum and Predictors of Refractory Status Epilepticus in a Developing Country

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.28 ◽

2017 ◽

Vol 44 (5) ◽

pp. 538-546 ◽

Cited By ~ 2

Author(s):

Deepanshu Dubey ◽

Sanjeev K. Bhoi ◽

Jayantee Kalita ◽

Usha K. Misra

Keyword(s):

Status Epilepticus ◽

Developing Country ◽

Care Center ◽

Tertiary Care ◽

Refractory Status Epilepticus ◽

Cns Infection ◽

Metabolic Encephalopathy ◽

Refractory Status ◽

The Status ◽

Poor Outcomes

AbstractObjective: Refractory status epilepticus (RSE) can influence the outcome of status epilepticus (SE). In the present study, we report the aetiology and predictors of outcomes of RSE in a developing country. Methods: This is a prospective hospital-based study of SE patients (continuous seizures for five minutes or more). Those who had SE persisting after two antiepileptic drugs were defined as having RSE. We present the demographic information, duration, and type of SE, and we note its severity using the status epilepticus severity score (STESS), its aetiology, comorbidities and imaging findings. The outcome of RSE was defined as cessation of seizures and the condition upon discharge, as assessed by the modified Rankin Scale. Results: A total of 35 (42.5%) of our 81 patients had RSE. The median duration of SE before starting treatment was 2 hours (range=0.008-160 h). The most common causes of RSE were stroke in 5 (14.3%), central nervous system (CNS) infections in 12 (34.3%) and metabolic encephalopathies in 13 (37.1%) patients. Some 21 (60%) patients had comorbidities, and the STESS was favourable in 7 (20%) patients. A total of 14 (20%) patients died, but death was directly related to SE in only one of these. Some 10 patients had super-refractory status epilepticus, which was due to CNS infection in 5 (50%) and metabolic encephalopathy in 3 (30%). On multivariate analysis, an unfavourable STESS (p=0.05) and duration of SE before treatment (p=0.01) predicted RSE. Metabolic aetiology (p=0.05), mechanical ventilation (p<0.001) and age >60 years (p=0.003) were predictors of poor outcomes. Conclusions: RSE was common (42.5%) among patients with SE in a tertiary care center in India. It was associated with high mortality and poor outcomes. Age above 60 years and metabolic aetiology were found to be predictors of poor outcomes.

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Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Neurology ◽

10.1212/wnl.0000000000003550 ◽

2016 ◽

Vol 88 (4) ◽

pp. 386-394 ◽

Cited By ~ 18

Author(s):

Iván Sánchez Fernández ◽

Michele C. Jackson ◽

Nicholas S. Abend ◽

Ravindra Arya ◽

James N. Brenton ◽

...

Keyword(s):

Status Epilepticus ◽

Refractory Status Epilepticus ◽

Convulsive Status Epilepticus ◽

Similar Time ◽

Refractory Status ◽

History Of ◽

To Receive ◽

Observational Descriptive Study ◽

Timely Administration ◽

Timely Treatment

Objective:To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).Methods:This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month–21 years of age) with rSE.Results:We enrolled 189 participants (53% male) with a median (25th–75th percentile) age of 4.2 (1.3–9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5–60] vs 16.5 [5–42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46–190] vs 50.5 [28–116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5–22.3] vs 20 [5–60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3–124] vs 65 [32.5–156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset.Conclusions:Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.

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New-Onset Refractory Status Epilepticus: More Investigations, More Questions

Case Reports in Neurology ◽

10.1159/000447295 ◽

2016 ◽

Vol 8 (2) ◽

pp. 127-133 ◽

Cited By ~ 7

Author(s):

Philippe Dillien ◽

Susana Ferrao Santos ◽

Vincent van Pesch ◽

Vanessa Suin ◽

Sophie Lamoral ◽

...

Keyword(s):

Status Epilepticus ◽

Immune Therapy ◽

Healthy Woman ◽

Refractory Status Epilepticus ◽

Refractory Status ◽

The Status ◽

Third Line Therapy ◽

High Doses ◽

Third Line ◽

New Onset

A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

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