Refractory status epilepticus seizure european journal of epilepsy. Frequency of refractory status epilepticus in status epilepticus patients 3144% no community based incidence studies in india but is expected to be high because of high prevalence of epilepsy, cns infections and treatment gap. Early recognition and initiation of treatment leads to a better response and may improve outcomes. Management of refractory status epilepticus in adults. J k murthy convulsive status epilepticus api india 20 3. The american epilepsy society guidelines published in. Status epilepticus and refractory status epilepticus. Frequency and prognosis of convulsive status epilepticus of. Outcomes and complications vary greatly among these types of sta.
The concept of super refractory status and newer etiologies and therapeutic options are also discussed. If seizures persist after adequate doses of a benzodiazepine and fosphenytoin, then refractory status epilepticus is diagnosed. Surgery for refractory partial status epilepticus 383 episodes of myoclonic jerks were observed on the left side of his body and palate. Thus, putting a patient into a pentobarbital coma commits them to a 12 week ventilator course. An important observation in both human and animal studies is an electroencephalography eeg progression toward status epilepticus. Many factors often combine to lower the patients seizure threshold. Treatment of refractory status epilepticus rse frequently requires application of more than three antiepileptic drugs aeds. Common intravenous agents such as diazepam, lorazepam, midazolam, and phenytoin used to treat rse have frequent problems with toxicity or efficacy 35. Major independent outcome predictors are age not modifiable and cause which should. It is an uncommon but important clinical problem with high mortality and morbidity rates. Refractory status epilepticus rse has been defined variably in the literature as seizures that do not respond to 2 14 or 3 58 different antiepileptic medications, usually intravenous benzodiazepines as a firstline agent and intravenous phenytoin, phenobarbital, or valproic acid as a secondline agent. New status epilepticus guidelines epilepsy foundation. Status epilepticus is a medical emergency with a high mortality.
Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain. Cryptogenic new onset refractory status epilepticus norse. There are a variety of treatments used, almost entirely based on open observational studies or case reports. Cole epilepsy service, department of neurology, acc 835, massachusetts general hospital, harvard medical school, boston, ma 02114, usa. The exact definition is still unclear, with different studies defining refractory status epilepticus with varying durations no time criteria, 30 minutes, 1 hour, or 2 hours and a lack of response to numbers two or three and types of medications. Guidelines for the evaluation and management of status. Nov 08, 2017 refractory status epilepticus falls under the status epilepticus category where the patient continues to show the epilepticus even while continuing the treatment using benzodiazepines and antiepileptic medicines. Refractory and superrefractory status epilepticusan update. Show full abstract patient with refractory status epilepticus, and he was managed with sevoflurane, an inhalational anesthetic. The role of anesthetics and immune therapies warrants further investigation. Refractory status epilepticus is defined as status epilepticus that persists despite treatment with at least two antiepileptic drugs.
Management of refractory and superrefractory status epilepticus. Refractory and superrefractory status epilepticus indian pediatrics. Refractory status epilepticus rse is defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. Basic physiology of limbic status epilepticus walker 2009. The term superrefractory status epilepticus was introduced. The different electroclinical types of status epilepticus share eeg characteristics. Refractory status epilepticus falls under the status epilepticus category where the patient continues to show the epilepticus even while continuing the treatment using benzodiazepines and antiepileptic medicines. Proposed algorithm for convulsive status epilepticus. Apr 24, 2014 status epilepticus is a medical emergency with a high mortality. Transitioning treatment from status epilepticus to super refractory status epilepticus david roy, pharmd pgy1 pharmacy resident. Ketamine is rapid onset and relatively safe for refractory status epilepticus.
Refractory status epilepticus occurs in 1070% of adults. Our approach to the epilepsies in childhood has been clarified by the broad separation into benign and malignant syndromes. In the context of prevention and treatment processes, it is not only necessary to terminate epileptic seizures, but to also address the disruption of the patients. Newonset refractory status epilepticus norse is a recently coined term for refractory status epilepticus where. Efns guideline on the management of status epilepticus. Guidelines for the evaluation and management of status epilepticus. Status epilepticus and beyond acute and critical care. Refractory status epilepticus rse is continued seizures after the failure of two or more aeds. Refractory status epilepticus is a potentially lifethreatening medical emergency. The article summarises the causes, effects, pathophysiology and treatment protocols for refractory status epilepticus. Mar, 2020 super refractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency. Treatment of refractory partial status epilepticus with.
Status epilepticus is a medical and neurologic emergency that requires prompt evaluation and treatment. It is likewise necessary to attend to the refractory status epilepticus promptly to prevent mortality. Jan 14, 2015 frequency of refractory status epilepticus in status epilepticus patients 3144% no community based incidence studies in india but is expected to be high because of high prevalence of epilepsy, cns infections and treatment gap. Status epilepticus is a lifethreatening medical emergency, particularly if treatment is delayed. Generalized convulsive status epilepticus emcrit project. Some authorities have also defined rse on the basis of the duration of seizure for 1 or 2 hours. Refractory status epilepticus is one of the most common severe and acute diseases in neurology and neurocritical care. Rse should be treated promptly to prevent morbidity and mortality. Summary refractory status epilepticus, while a challenge to the intensivist, can be treated with drugs that are commonly used by intensivists.
We then summarise the data on the utility of extended eeg monitoring and emphasise the importance of early termination of status epilepticus. Apr 05, 2020 refractory and super refractory status epilepticus are lifethreatening conditions with many possible therapeutic approaches. This is a pdf file of an unedited manuscript that has been. Lastline agent for superrefractory status epilepticus. In this episode of hallway conversations, editorinchief dr.
The treatment of superrefractory status epilepticus. As there is a limited number of intravenous aeds, orally administered aeds represent a therapeutic option particularly for longer rse episodes. Tracy glauser, from the university of cincinnati, about new status epilepticus guidelines. The norse newonset refractory status epilepticus syndrome. Pdf refractory and superrefractory status epilepticusan. Newonset refractory status epilepticus norse is defined as a condition, not a specific diagnosis, with new onset of refractory status epilepticus without a clear acute or active structural, toxic or metabolic cause in a patient without active epilepsy. Status epilepticus superrefractory fires epilepsy anesthesia pediatric. However, the problem is that it has many sideeffects including hypotension, propylene glycol toxicity and an incredibly sluggish halflife. Effects of clobazam for treatment of refractory status. Refractory status epilepticus rse can be defined as status epilepticus that. After some of these myoclonic bouts a slight ipsilateral hemiparesis was noted with complete recovery within a few minutes. References status epilepticus care guideline agarwal p, et al. Outcomes of deviation from treatment guidelines in status epilepticus.
Ketamine for the treatment of refractory status epilepticus. Refractory status epilepticus is defined as recurrent seizure activity despite two appropriately selected and dosed antiepileptic drugs including a benzodiazepine. Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. Cryptogenic new onset refractory status epilepticus norse in adultsinfectious or not. Srse is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, including those cases in which the status epilepticus recurs on the reduction or withdrawal of anesthesia. The term superrefractory status epilepticus srse refers to a re fractory episode continuing under general anesthesia for more than 24 h. Management of superrefractory status epilepticus with. Predictors of outcome in refractory status epilepticus. These patients only entered in the intensive care unit.
It is a serious condition that requires prompt medical attention. Outcome at discharge is poor but improves during followup. Refractory and superrefractory status epilepticus are lifethreatening conditions with many possible therapeutic approaches. Treatment of refractory and superrefractory status epilepticus. Status epilepticus and refractory status epilepticus represent some of the most. There are also some promising new therapies on the horizon, both for the short and the longer terms. Superrefractory status epilepticus srse is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, and includes those cases in which epilepsy is recurrent upon treatment reduction. The term super refractory status epilepticus was introduced during the londoninnsbruck colloquium on status epilepticus in 2011 and refers to status epilepticus that continues or recurs 24 h or. The treatment and prognosis of refractory and super. The patient was given an inspired concentration of 0.
Refractory status epilepticus diagnosis and treatment. Randomized study of intravenous valproate and phenytoin in status epilepticus. Pediatric intensive care treatment of uncontrolled status epilepticus. How refractory is superrefractory status epilepticus a. The term superrefractory status epilepticus was introduced during the londoninnsbruck colloquium on status epilepticus in 2011 and refers to status epilepticus that continues or recurs 24 h or. Status epilepticus international league against epilepsy. In status epilepticus seizures appear in close succession or dont stop. However, limited evidence supports to a specific treatment that helps in curing. Additionally gene expression within few minutes of seizures and lack of synchrony. Pdf refractory and superrefractory status epilepticus. Patients who are diagnosed with refractory status epilepticus need rapid treatment, but the initiation of comainducing medications is associated with a high incidence of side effects and the need for intensive care admission. Epilepsyrefractory status epilepticuspentobarbitalpropofolmidazolam.
How refractory is superrefractory status epilepticus a personal iew. Convulsive status epilepticus cse is the most common neurological medical emergency and continues to be associated with significant morbidity and mortality. There is a lack of consensus upon its semantic definition of whether it is status epilepticus that continues despite treatment with benzodiazepine and one antiepileptic medication aed, i. He had up to three episodes per week and with the addition.
These underlying brain problems may include trauma, infections, or strokes among others. The factors that suggest a poorer outcome in terms of seizures, cognition, and behaviour include the presence of. Can an optimal approach be recommended based on available data. These patients were optimized using faes by combining two, three or four second line drugs if necessary. Superrefractory status epilepticusstatus epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency. Srse carries a high risk of morbidity and a high mortality rate ranging from 23 to 57% 2, 3. Super refractory status epilepticus is defined as status epilepticus that continues or recurs 24 h or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anaesthesia. Status epilepticus manifests as many different syndromes, each defined by distinctive clinical features and electroencephalography eeg findings.
Newonset refractory status epilepticus norse and febrile. Therapies for refractory convulsive status epilepticus. We are committed to sharing findings related to covid19 as quickly and safely as possible. Jan 28, 2015 super refractory status epilepticus srse is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, and includes those cases in which epilepsy is recurrent upon treatment reduction. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. Autoimmune encephalitis is the most commonly identified cause of newonset refractory status epilepticus, but half remain cryptogenic. Initially, there are repeated seizures that merge into continuous seizure activity and eventually periodic epileptiform discharges treiman, 1995. Proposed algorithm for convulsive status epilepticus from treatment of convulsive status epilepticus in children and adults, epilepsy currents 16.
378 1366 97 1309 89 1217 35 1022 487 1632 1093 965 754 920 317 528 462 38 1509 285 383 1515 25 1034 1184 1390 81 1278 1616 354 562 1459 140 1059 341 73 1188 1180 65 1140 1481 729 1186 601 643 1367