Refractory and Super-Refractory Status Epilepticus—an Update

  • Sara Hocker
  • William O. Tatum
  • Suzette LaRoche
  • W. David Freeman
Critical Care (SA Mayer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Critical Care


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.


Super refractory Status epilepticus EEG Anesthesia Critical care 


Compliance with Ethics Guidelines

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 ( 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.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sara Hocker
    • 1
  • William O. Tatum
    • 2
  • Suzette LaRoche
    • 3
  • W. David Freeman
    • 2
    • 4
    • 5
  1. 1.Department of NeurologyMayo ClinicRochesterUSA
  2. 2.Department of NeurologyMayo ClinicJacksonvilleUSA
  3. 3.Department of NeurologyEmory UniversityAtlantaUSA
  4. 4.Department of Critical CareMayo ClinicJacksonvilleUSA
  5. 5.Department of NeurosurgeryMayo ClinicJacksonvilleUSA

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