Methods in the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent eeg. The concept of super refractory status and newer etiologies and therapeutic options are also discussed. Additionally gene expression within few minutes of seizures and lack of synchrony. This case highlights the development and progression of generalized cerebral atrophy in super refractory status epilepticus. The treatment of superrefractory status epilepticus. The term superrefractory status epilepticus srse refers to a re fractory episode continuing under general anesthesia for more than 24 h. 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. In status epilepticus seizures appear in close succession or dont stop. It is likewise necessary to attend to the refractory status epilepticus promptly to prevent mortality. Transitioning treatment from status epilepticus to super refractory status epilepticus david roy, pharmd pgy1 pharmacy resident. How refractory is superrefractory status epilepticus a. Neurologic outcome of postanoxic refractory status. Md of massachusetts general hospital and harvard medical school explains super refractory status epilepticus.
Refractory status epilepticus is defined as persistent seizures despite. 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. Super refractory status epilepticus how long should we persevere. The treatment and prognosis of refractory and super. Many factors often combine to lower the patients seizure threshold. Superrefractory status epilepticusstatus epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis. Superrefractory status epilepticus explained youtube. Cryptogenic new onset refractory status epilepticus norse in adultsinfectious or not. These underlying brain problems may include trauma, infections, or strokes among others. 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. It is a serious condition that requires prompt medical attention.
New status epilepticus guidelines epilepsy foundation. This is a pdf file of an unedited manuscript that has been. Outcome at discharge is poor but improves during followup. Refractory status epilepticus occurs in 1070% of adults. Treatment of refractory and superrefractory status. J k murthy convulsive status epilepticus api india 20 3. Newonset refractory status epilepticus norse and febrile. It is an uncommon but important clinical problem with high mortality and morbidity rates. Management of refractory status epilepticus involves treatment of an. Status epilepticus is a lifethreatening medical emergency, particularly if treatment is delayed. Newonset refractory status epilepticus johns hopkins. However, limited evidence supports to a specific treatment that helps in curing. A variety of potential causes exist for status epilepticus, refractory status epilepticus, and super refractory status epilepticus, but all three ultimately involve changes at the cellular and molecular level.
The article summarises the causes, effects, pathophysiology and treatment protocols for refractory status epilepticus. 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. Refractory status epilepticus creighton university. Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain. Cole epilepsy service, department of neurology, acc 835, massachusetts general hospital, harvard medical school, boston, ma 02114, usa. Superrefractory status epilepticus and febrile infection. Status epilepticus is a neurologic emergency and can progress to refractory status epilepticus and super refractory status epilepticus. Newonset refractory status epilepticus norse is a recently coined term for refractory status epilepticus where. Generalized convulsive status epilepticus emcrit project. Randomized study of intravenous valproate and phenytoin in status epilepticus. References status epilepticus care guideline agarwal p, et al.
Because of the small numbers, there are no definitive studies regarding. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory csf changes. The term superrefractory status epilepticus was introduced during the londoninnsbruck colloquium on status epilepticus in 2011 and refers to status epilepticus that continues or. Evolution of cerebral atrophy in a patient with super. Management of superrefractory status epilepticus with. How refractory is super refractory status epilepticus a personal iew. The treatment of superrefractory status epilepticus neurology. Several recent guidelines and consensus statements highlight the critical role of continuous eeg ceeg monitoring during prolonged treatment. 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. Autoimmune encephalitis is the most commonly identified cause of newonset refractory status epilepticus, but half remain cryptogenic. Super refractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency.
Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. Treatment of rse has not been studied prospectively, and guidelines give a variety of options. Refractory status epilepticus is a potentially lifethreatening medical emergency. Gaps and opportunities in refractory status epilepticus. Guidelines for the evaluation and management of status. Ketogenic diet in 3 cases of childhood refractory status epilepticus. Status epilepticus, refractory status epilepticus, and. A definition and classification of status epilepticus report of the ilae task force on classification of status epilepticus. 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. Predictors of outcome in refractory status epilepticus.
There are a variety of treatments used, almost entirely based on open observational studies or case reports. 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. Some authorities have also defined rse on the basis of the duration of seizure for 1 or 2 hours. Status epilepticus international league against epilepsy. Refractory and superrefractory status epilepticus indian pediatrics. The different electroclinical types of status epilepticus share eeg characteristics. Refractory status epilepticus rse can be defined as status epilepticus that. Treatment of refractory and superrefractory status epilepticus. Management of patients with status epilepticus generally requires several. 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. Cryptogenic new onset refractory status epilepticus norse. Treatment of rse has not been studied in a prospective trial, and. Treatment of refractory status epilepticus stephan schuele, md, mph northwestern university chicago, il definition refractory status epilepticus rse is defined as seizure activity which persists for over 2 hours and after failing two first line treatments, usually a benzodiazepine and a conventional intravenous antiepileptic medication.
Apr 21, 2016 super refractory status epilepticus explained rare disease report. With the exception of anaesthetic coma, which is not sustainable, and the ketogenic diet in some patients 2, 3. 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. The cerebral atrophy was noticeable at 31 days after admission at our facility which emphasizes the urgency of definitive treatment in patients who present with super refractory status epilepticus. Superrefractory status epilepticus is defined as status epilepticus that continues or recurs 24h.
Pdf refractory and superrefractory status epilepticus. Nicholas hirsch neuromedical intensive care unit the national hospital for neurology and neurosurgery queen square london state of the art meeting 2015 2. Refractory status epilepticus is defined as status epilepticus that persists despite. The american epilepsy society guidelines published in. Objective to investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus rse treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other eeg patterns. Electroencephalography is the gold standard for diagnosis. 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. The norse newonset refractory status epilepticus syndrome. Treatment of refractory and superrefractory status epilepticus ncbi. In this episode of hallway conversations, editorinchief dr. Pdf refractory and superrefractory status epilepticusan. Tracy glauser, from the university of cincinnati, about new status epilepticus guidelines. Efns guideline on the management of status epilepticus. Febrile infectionrelated epilepsy syndrome fires is a rare but devastating epileptic encephalopathy typically affecting schoolaged children, characterized by a preceding febrile illness, followed by multifocal seizures and often refractory status epilepticus rse 1.
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