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. 2022 Aug 22;4(1):35.
doi: 10.1186/s42466-022-00199-4.

Super-refractory status epilepticus in adults

Michael P Malter  1 , Janina Neuneier  2
Affiliations

Super-refractory status epilepticus in adults

Michael P Malter et al. Neurol Res Pract. .

Abstract

Introduction: Super-refractory status epilepticus (SRSE) represents the culmination of refractory status epilepticus (RSE) and carries a significant risk of poor neurological outcome and high mortality. RSE is not defined primarily by seizure duration, but by failure to respond to appropriate antiseizure treatment. SRSE is present when a RSE persists or recurs after more than 24 h of treatment with anesthetics. No evidence-based treatment algorithms can be provided for SRSE. Therefore, we propose a pragmatic standard operating procedure (SOP) for the management of SRSE that addresses the existing uncertainties in the treatment of SRSE and provides options for resolution and decision-making.

Comments: First, we recommend the assessment of persistent seizure activity and the evaluation of differential diagnoses to confirm correct diagnosis. Relevant differential diagnoses include psychogenic non-epileptic seizures, hypoxic, metabolic, or toxic encephalopathies, and tetanus. During SE or in severe encephalopathies, a so-called electroclinical ictal-interictal continuum may occur, which denotes an intermediate stage that cannot be defined with certainty as ictal or interictal by EEG and should not lead to harmful overtreatment. Because both prognosis and specific treatment options depend crucially on the etiology of SRSE, the etiological evaluation should be performed rapidly. When SRSE is confirmed, various pharmacological and non-pharmacological treatment options are available.

Conclusion: We provide a pragmatical SOP for adult people with SRSE.

Keywords: Epilepsy; Seizures; Standard operating procedure; Standard operating procedure (SOP); Status epilepticus; Super-refractory status epilepticus.

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Conflict of interest statement

MPM and JN report no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the  proposed algorithm for the management of SRSE. Abbreviations: EEG: electroencephalography; NCSE: non-convulsive status epilepticus; ED: epileptiform discharges on EEG; i.v.: intravenous; ASM: antiseizure medication; SRSE: super-refractory status epilepticus; CK: creatine kinase; BSP: burst-suppression pattern on EEG
See this image and copyright information in PMC

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