Outcome at discharge is poor but improves during followup. Management of refractory status epilepticus in adults. Superrefractory status epilepticus is defined as status epilepticus that continues or recurs 24h. The treatment of superrefractory status epilepticus neurology. A metaanalysis of 111 children indicated that midazolam was as effective as other coma inducing medications and involved a lower mortality zero with midazolam 28. This is a pdf file of an unedited manuscript that has been.
Status epilepticus is a medical emergency with a high mortality. Intravenous ketamine in status epilepticus hofler 2018. Several recent guidelines and consensus statements highlight the critical role of continuous eeg ceeg monitoring during prolonged treatment. The 2012 guidelines for the evaluation and management of status epilepticus 12 provides a brief assessment for alternative epilepsy treatment. Guidelines for the evaluation and management of status epilepticus. Impact of timing of continuous intravenous anesthetic drug treatment. Management of refractory status epilepticus involves treatment of an. The american epilepsy society guidelines published in. Several studies reported on the use of midazolam in refractory status epilepticus, using different dosing and treatment goals 7,2231. 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. Treatment of refractory and superrefractory status epilepticus ncbi. For patients with refractory status epilepticus, iv continuous. Refractory status epilepticus is defined as persistent seizures despite. 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.
Refractory and superrefractory status epilepticus indian pediatrics. Pdf refractory and superrefractory status epilepticus. It is an uncommon but important clinical problem with high mortality and morbidity rates. Refractory status epilepticus rse can be defined as status epilepticus that. In this setting, reinitiating the prescribed antiepilep tic or escalating the tapered medication may be prudent. Treatment of rse has not been studied prospectively, and guidelines give a variety of options. Numerous multifocal mainly subclinical seizures migrating independently over the right and left hemispheres a. Superrefractory status epilepticus and febrile infection. Superrefractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis. Patients in refractory status epilepticus rse may require treatment with. Refractory status epilepticus is defined as recurrent seizure activity despite two appropriately selected and dosed antiepileptic drugs including a benzodiazepine. Treatment of refractory and superrefractory status.
Management of superrefractory status epilepticus with. Autoimmune encephalitis is the most commonly identified cause of newonset refractory status epilepticus, but half remain cryptogenic. The role of anesthetics and immune therapies warrants further investigation. The treatment of superrefractory status epilepticus.
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