scholarly journals Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus

2018 ◽  
Vol 31 (10) ◽  
pp. 598 ◽  
Author(s):  
Daniel Gomes ◽  
José Pimentel ◽  
Carla Bentes ◽  
Diana Aguiar de Sousa ◽  
Ana Patrícia Antunes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Units ◽  
Case Reports ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Refractory Status Epilepticus ◽  
Consensus Protocol ◽  
Level Of Evidence ◽  
Refractory Status

Introduction: Super-refractory status epilepticus is defined as status epilepticus that persists or recurs 24 hours after anaesthetic therapy onset or after its withdrawal. It is mostly found in intensive care units and carries high mortality but good long-term prognosis for those who survive. In contrast with the initial phases of status epilepticus, treatment lacks strong scientific evidence and is mostly derived from case reports or small case series.Objective: To propose a protocol for the treatment of super-refractory status epilepticus in level III intensive care units, focusing on the treatment strategies to control clinical and/or electroencephalographic epileptic activity.Material and Methods: Narrative review of the literature by PubMed search. Available evidence was discussed in consensus meetings by intensive care and neurology experts’ from a level III intensive care unit and one of the Portuguese reference centres for the treatment of refractory epilepsy, respectively.Results: Anaesthetics with the highest level of evidence are propofol, midazolam, thiopental and ketamine. These represent the basis of the treatment of super-refractory status epilepticus and should be used in combination with antiepileptic drugs. The level of evidence for the latter is lower, however, levetiracetam, topiramate, pregabalin, lacosamide, valproic acid, phenytoin and perampanel may be recommended. Alternative therapeutic strategies with very low level of evidence are recommended in cases of total absence of clinical response, such as magnesium sulphate, pyridoxine, ketogenic diet, therapeutic hypothermia and immunosupression.Conclusion: We propose a treatment protocol based on a sequential combination of anaesthetics, anti-epileptic drugs and alternative therapies. Strategies to evaluate treatment response and to wean drugs based on clinical results are also proposed.

Ketogenic Diet in Status Epilepticus

2016 ◽  
Author(s):  
Rima Nabbout
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Units ◽  
Ketogenic Diet ◽  
Significant Risk ◽  
Refractory Status Epilepticus ◽  
Dietary Therapy ◽  
Risk Of Death ◽  
Refractory Status ◽  
Neurological Morbidity

Refractory status epilepticus (RSE) is associated with a significant risk of death or neurological morbidity. The ketogenic diet (KD) is a dietary therapy that succeeds in controlling seizures in otherwise RSE in children and adult patients. Inflammatory etiologies might be a particular target, but KD has reported efficacy in other etiologies. KD is well tolerated, and the effect is seen within days. Randomized and controlled studies are lacking in this area, and studies are needed to prove the efficacy of KD in RSE and to identify specific indications. This would help to increase its use and to implement it in intensive care units to resolve severe epileptic conditions quickly.

scholarly journals Refractory Status Epilepticus: Experience in a Neurological Intensive Care Unit

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
O. H. Hernandez ◽  
J. F. Zapata ◽  
M. Jimenez ◽  
M. Massaro ◽  
A. Guerra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Short Term ◽  
Neurological Intensive Care Unit ◽  
Term Outcome ◽  
Neurological Intensive Care ◽  
Refractory Status ◽  
Short Term Outcome

Introduction. Refractory status epilepticus (RSE) has significant morbidity and mortality, and its management requires an accurate diagnosis and aggressive treatment. Objectives. To describe the experience of management of RSE in a neurological intensive care unit (NeuroICU) and determine predictors of short-term clinical outcome. Methods. We reviewed cases of RSE from September 2007 to December 2008. Management was titrated to findings on continuous video EEG (cVEEG). We collected patients’ demographics, RSE etiology, characteristics of seizures, cVEEG findings, treatments, and short-term outcome. Control of RSE was to achieve burst suppression pattern or electrographic cessation of ictal activity. Results. We included 80 patients; 63.8% were in coma, 25% had subclinical seizures, and 11.3% had focal activity. 51.3% were male and mean age was 45 years. Etiology was neurological lesion in 75.1%, uncontrolled epilepsy in 20%, and systemic derangements in 4.9%. 78.8% were treated with general anesthesia and concomitant anticonvulsant drugs. The control of RSE was 87.5% of patients. In-hospital mortality was 22.5%. The factors associated with unfavorable short-term outcome were coma and age over 60 years. Conclusions. RSE management guided by cVEEG is associated with a good seizure control. A multidisciplinary approach can help achieve a better short-term functional outcome in noncomatose patients.

scholarly journals The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

2017 ◽  
Vol 01 (03) ◽  
pp. E204-E210
Author(s):  
Stephanie Gollwitzer ◽  
Hajo Hamer
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Evidence Based ◽  
New Approach ◽  
Refractory Status ◽  
First Choice ◽  
Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

Perampanel Treatment for Refractory Status Epilepticus in a Neurological Intensive Care Unit

2019 ◽  
Vol 31 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Chen-Jui Ho ◽  
Chih-Hsiang Lin ◽  
Yan-Ting Lu ◽  
Fu-Yuan Shih ◽  
Che-Wei Hsu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Neurological Intensive Care Unit ◽  
Neurological Intensive Care ◽  
Refractory Status

Detection and Treatment of Refractory Status Epilepticus in the Intensive Care Unit

2008 ◽  
Vol 25 (4) ◽  
pp. 181-186 ◽  
Author(s):  
Frank W. Drislane ◽  
Maria R. Lopez ◽  
Andrew S. Blum ◽  
Donald L. Schomer
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Refractory Status

Surgical treatment of refractory status epilepticus in children

2013 ◽  
Vol 12 (4) ◽  
pp. 360-366 ◽  
Author(s):  
Sanjiv Bhatia ◽  
Faiz Ahmad ◽  
Ian Miller ◽  
John Ragheb ◽  
Glenn Morrison ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Unit Stay ◽  
Surgical Intervention ◽  
Refractory Status Epilepticus ◽  
High Dose ◽  
High Morbidity ◽  
Ictal Spect ◽  
Refractory Status

Object Refractory status epilepticus (RSE) is a life-threatening neurological emergency associated with high morbidity and mortality. Affected patients often require prolonged intensive care and can suffer multiple complications. Surgical intervention to control RSE is rarely used but can obviate the risks of prolonged seizures and intensive care treatment. Authors of the present study analyzed their experience with the surgical management of patients suffering from RSE. Methods The Epilepsy Surgery Database at Miami Children's Hospital was reviewed for patients who had undergone surgery for RSE. Clinical presentation, electrophysiological profile, radiological data, surgical details, and postoperative course were evaluated. Results Between 1990 and 2012, 15 patients underwent surgery for uncontrolled seizures despite high-dose medical suppressive therapy. The mean preoperative duration of status epilepticus was 8 weeks. Ictal SPECT and FDG-PET imaging in conjunction with intraoperative electrophysiological studies helped to outline the extent of resection. Surgical intervention controlled seizures in all patients and facilitated the transition out of intensive care. Adverse events related to a prolonged intensive care unit stay included sepsis and respiratory complications. Four patients had worsened neurological function, developing hemiparesis and dysphasia. There was no operative mortality. Conclusions Surgical intervention can successfully control refractory partial status epilepticus, prevent associated morbidity, and decrease intensive care unit stay. Ictal SPECT and PET are valuable in guiding resection.

Sign in / Sign up

Export Citation Format

Share Document