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Treatment of Refractory and Super-Refractory Status Epilepticus

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Status Epilepticus

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Refractory and super-refractory status epilepticus are acute neurologic emergencies with high mortality rates, and over half of survivors have poor functional outcomes. The treatment itself portends additional risk of morbidity and mortality. This chapter provides a comprehensive overview of the pharmacologic treatment of refractory and super-refractory status epilepticus. Treatment aggressiveness, drug selection, and dosing are discussed, including both anesthetic and non-anesthetic anti-seizure drugs. An in depth review of propofol, midazolam, ketamine, and barbiturate drugs, including thiopental and pentobarbital, is provided. Mirroring the daily care of patients with refractory and super-refractory status epilepticus, the chapter emphasizes the complications of anesthetic therapies and when possible, how to prevent them. Less frequently discussed aspects of treatment including the electroencephalogram suppression target, principles of weaning anesthetic drugs, and what to do in between weaning attempts, are addressed. Also included is a section on when and how to initiate a trial of immunotherapy for cryptogenic or antibody-mediated refractory status epilepticus.

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Authors and Affiliations

  1. Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Sara Hocker

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  1. Sara Hocker
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Correspondence to Sara Hocker .

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Editors and Affiliations

  1. Department of Neurology, Harvard Medical School, Comprehensive Epilepsy Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Frank W. Drislane

  2. Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA

    Peter W. Kaplan MBBS

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Hocker, S. (2018). Treatment of Refractory and Super-Refractory Status Epilepticus. In: Drislane, F., Kaplan MBBS, P. (eds) Status Epilepticus. Current Clinical Neurology. Springer, Cham. https://doi.org/10.1007/978-3-319-58200-9_17

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