Refractory and Super-Refractory Status Epilepticus: Therapeutic Options and Prognosis

Abstract

In patients with status epilepticus (SE), the underlying biologic background represents the main prognostic variable. A swift application of a treatment protocol is recommended, including adequate doses of a benzodiazepine followed by an intravenous anti-seizure medicine. If refractory SE arises, general anesthetics should be used in generalized convulsive and non-convulsive SE in coma, while further non-sedating anti-seizure medications attempts are warranted in patients with focal forms. Ketogenic diet and/or ketamine in patients with super-refractory SE, and immunologic treatments for those with new-onset refractory SE/febrile-induced refractory epilepsy syndrome should be considered early. Pharmacologic treatment of SE after cardiac arrest should be oriented by the results of multimodal prognostication.

Keywords: Continuous electroencephalogram; General anesthetics; Ketogenic diet; Mortality; Outcome; Treatment.