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 srse refers to a re fractory episode continuing under general anesthesia for more than 24 h. The premier hospital database was utilized to estimate the number of srse cases based on hospital discharges during 2012. Firstinman allopregnanolone use in super refractory status epilepticus henrikas vaitkevicius1,2, aatif m. Jun 23, 2015 a study with sage547 for superrefractory status epilepticus the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Burden of illness for superrefractory status epilepticus. Patients usually present with altered mental status, cognitive impairment and refractory seizures. Management of superrefractory status epilepticus with. A status epilepticus which persists for 24 hours or more after starting treatment with anaesthesia or has recurred inspite of general anesthesia is known as super refractory status epilepticus srse. The premier hospital database was utilized to estimate the number of.
Pdf the treatment of superrefractory status epilepticus. It has recently presented in an unclear pattern, and thus there are various challenges in its management in resource. Super refractory status epilepticus is that which persists despite suitable treatment with multiple anticonvulsive schemes, including prolonged coma with general anaesthetic. In all these cases, the processes that normally terminate seizures have proved insuf. To provide an estimate of the annual number of super refractory status epilepticus srse cases in the us and to evaluate utilization of hospital resources by these patients.
Rosenthal2,4, jonathan rosand2,4, wendell bobb3, kiran reddy5, michael a. A study of super refractory status epilepticus from india. Refractory status epilepticus presenting as shaken baby syndrome. We present a case of super refractory status epilepticus srse in a previously healthy 38yearold righthanded man who initially presented at an outside hospital after a car accident. Generalized convulsive status epilepticus emcrit project. A 72yearold man presented with a super refractory partial status epilepticus following evacuation of a right subdural hematoma. A survival case of superrefractory status epilepticus due. He failed to respond to treatment with high doses of intravenous valproic acid, levetiracetam, lacosamide, thiopental, and midazolam. It includes cases where status epilepticus recurs on reduction or withdrawal of anaesthesia. 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.
Distinguish gaps in the literature related to optimal status epilepticus treatment. Newonset refractory status epilepticus norse is defined as newonset rse where no discernible cause is identifiable in otherwise healthy individuals 5, 6. This article presents an overview of the three conditions and discusses their management and outcomes. A yearolds superrefractory status epilepticus lands her in the pediatric icu. It is an uncommon but important clinical problem with high mortality and morbidity rates. Informed consent statement was obtained for this study. Role of the ketogenic diet in acute neurological diseases.
Status epilepticus, refractory status epilepticus, and super. Predictors of outcome in refractory status epilepticus. A study with sage547 for superrefractory status epilepticus the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Super refractory status epilepticus srse represent a serious neurological condition in paediatric intensive care units. Super refractory status epilepticus srse is an important and recently recognized neurological emergency. Cole2,4 1department of neurology, brigham and womens hospital, boston, massachusetts 2harvard medical school, boston, massachusetts. To summarize the available evidence related to pediatric refractory status epilepticus rse and super refractory status epilepticus srse, with emphasis on epidemiology, etiologies, therapeutic approaches, and clinical outcomes.
Refractory and superrefractory status epilepticus in adults. Oral perampanel for the treatment of superrefractory status. Treatment of superrefractory status epilepticus springerlink. 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. Cole2,4 1department of neurology, brigham and womens hospital, boston, massachusetts 2harvard medical school, boston. Superrefractory status epilepticus pdf free download. Jan 28, 2015 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. Literature on newonset refractory status epilepticus norse is scarce and management is guided mainly by retrospective reports, short case series or expert opinions. Aug 25, 2015 superrefractory status epilepticus srse is a devastating neurological condition with limited treatment options. 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. Brief communication firstinman allopregnanolone use in super refractory status epilepticus henrikas vaitkevicius1,2, aatif m. San luis case presentation a 35 yearold woman with a history of thyroid nodules, thyroidectomy and migraines presented with a feeling of chills and headaches in the primary care clinic and was diagnosed with a viral illness. The treatment and prognosis of refractory and super. Determinants and predictors of outcome in super refractory.
Superrefractory 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. Super refractory status epilepticus srse is defined as status epilepticus that continues or recurs 24 hours or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anaesthesia. Status epilepticus, refractory status epilepticus, and. If the seizures do not respond despite administration of appropriate firstline and secondline drugs it is called refractory status epilepticus rse whereas seizures that persist for 24 h or more after the initiation of treatment with an anesthetic agent is referred to as super refractory status epilepticus.
Status epilepticus, refractory status epilepticus, and superrefractory status epilepticus can be lifethreatening conditions. Pediatric refractory and superrefractory status epilepticus. Propofolketamine combination therapy for effective control of super refractory status epilepticus. The treatment of superrefractory status epilepticus. Superrefractory status epilepticus srse is a devastating neurological condition with limited treatment options. Superrefractory status epilepticusstatus epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency. Oral perampanel for the treatment of superrefractory. Treatment of refractory and superrefractory status epilepticus. Listing a study does not mean it has been evaluated by the u.
However, super refractory status epilepticus also occurs frequently in previously healthy patients without obvious cause. A study with sage547 for superrefractory status epilepticus. Aug 17, 2015 a yearolds superrefractory status epilepticus lands her in the pediatric icu. To describe a case series of adult patients in the intensive care unit in superrefractory status epilepticus srse. Usually, this condition occurs because of serious brain damage. Different pharmacological treatment schemes have been proposed in these. Treatment of refractory and superrefractory status. It is of two main types with either prolonged complex partial seizures or absence seizures. We conducted an extensive literature search to identify and summarize the therapeutic options for srse.
The search mainly resulted in case reports of various pharmacologic and nonpharmacologic treatments. Mar 27, 2020 refractory status epilepticus presenting as shaken baby syndrome. A synergistic anticonvulsant effect between the two drugs is proposed partly because of their di verse action on gammaaminobutyric acid gaba receptors and the inhibition of glutamate nmda re ceptors of valproate. Many of the recommended doses or targeted therapeutic levels are higher than referenced in the literature and based upon expert opinions at nyph. Assess the impact of timing of status epilepticus treatment initiation, and develop strategies to optimize effective treatment. Super refractory status epilepticus is known to typically arise either from a distinct underlying cause or, in patients with no history of epilepsy, from no overt cause. Frontiers a study of super refractory status epilepticus. A survival case of superrefractory status epilepticus due to. Nonconvulsive status epilepticus is a relatively long duration change in a persons level of consciousness without large scale bending and extension of the limbs due to seizure activity. Srse, though infrequently seen, constitutes a medical emergency due to the associated high morbidity. Super refractory status epilepticus is defined as status epilepticus that continues 24 h or more after the onset of anaesthesia, including those cases in which the status epilepticus recurs on the reduction or withdrawal of anaesthesia. We report a case of antigadassociated limbic encephalitis, presenting with super refractory status epilepticus. Misra, jayantee kalita and deepanshu dubey department of neurology, sanjay gandhi postgraduate institute of medical sciences, lucknow, india background. He was the driver, and had a witnessed convulsive event at the scene.
There are a variety of treatments used, almost entirely based on open observational studies or case reports. Transitioning treatment from status epilepticus to super refractory status epilepticus david roy, pharmd pgy1 pharmacy resident. Evaluate therapeutic strategies for super refractory status epilepticus. It is an uncommon but important clinical problem with a high mortality and morbidity. Ketamine for the treatment of super refractory status.
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