Refractory and Super-Refractory Status Epilepticus—an Update
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Status epilepticus is a medical emergency with a high mortality. Early recognition and initiation of treatment leads to a better response and may improve outcomes. Refractory status epilepticus is defined as recurrent seizure activity despite two appropriately selected and dosed antiepileptic drugs including a benzodiazepine. The term “super-refractory status epilepticus” was introduced during the London–Innsbruck Colloquium on status epilepticus in 2011 and refers to status epilepticus that continues or recurs 24 h or more after the initiation of treatment with anesthetic antiepileptic drugs. This includes cases in which seizure control is attained after induction of anesthesia but recurs on weaning the patient off the anesthetic agent. This article reviews the approach to refractory status epilepticus and super-refractory status epilepticus, including management as well as common pathophysiological causes of these entities.
KeywordsSuper refractory Status epilepticus EEG Anesthesia Critical care
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Conflict of Interest
Sara Hocker is a member of the steering committee for the Global Audit of Treatment of Refractory and Super-Refractory Status Epilepticus (https://www.status-epilepticus.net) and serves as a member of a data safety monitoring board for SAGE Therapeutics.
William O. Tatum declares that he has no conflict of interest or any financial disclosures with relation to this work.
Suzette LaRoche has received research funding from the National Institutes of Health Small Business Innovation Research program in collaboration with Optima Neurosciences and royalties from Demos Publishing.
W. David Freeman presented some information verbally and in syllabus form (but retained copyright) at the American Academy of Neurology on April 22, 2012.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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