Listing a study does not mean it has been evaluated by the u. Superrefractory status epilepticus is named for those continuous unabated,prolonged seizure activity, despite aggressive treatment including general anesthesia, lasting more than 24 hours. Guidelines for the evaluation and management of status. Usually, this condition occurs because of serious brain damage. To describe a case series of adult patients in the intensive care unit in superrefractory status epilepticus srse. Treatment of refractory and superrefractory status epilepticus. Refractory status epilepticus is defined as status epilepticus that continues despite treatment with benzodiazepines and one antiepileptic drug. This is the first report of anakinra for treatment of a child with super refractory status epilepticus secondary to fires. Newonset refractory status epilepticus genetic and rare. 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 to first and secondline antiepileptic agents. Pdf refractory and superrefractory status epilepticusan update. Research open access the ketogenic diet for paediatric.
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. It is an uncommon but important clinical problem with a high mortality and morbidity. Pdf superrefractory status epilepticus researchgate. The cases considered here are of convulsive status epilepticus and we have not. Management of refractory status epilepticus involves treatment of an. Treatment of refractory and superrefractory status. Newonset refractory status epilepticus norse and febrile. Refractory status epilepticus rse is continued seizures after the failure of two or more aeds. Refractory to two antiepileptic agents and general anesthesia treatment for 24 hours.
Aug 25, 2015 super refractory status epilepticus srse is a devastating neurological condition with limited treatment options. Super refractory status epilepticus srse is defined as an epileptic status that. Clinical features and outcome of superrefractory status. We conducted an extensive literature search to identify and summarize the therapeutic options for srse. We report a case of antigadassociated limbic encephalitis, presenting with superrefractory status epilepticus. Super refractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency. Treatment of rse has not been studied prospectively, and guidelines give a variety of options. How refractory is superrefractory status epilepticus a. Superrefractory status epilepticus status epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency.
F, flulike symptoms, and low back pain, and was discharged. A yearolds superrefractory status epilepticus lands her in the pediatric icu. Predictors of outcome in refractory status epilepticus. The economic impact of srse treatment remains unclear.
Superrefractory 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. Varied characteristics and treatment approaches, the growing use of continuous eeg monitoring, and insights into the underlying biology and. More likely to be due to acute encephalitis 30516601. Determinants and predictors of outcome in super refractory. He was the driver, and had a witnessed convulsive event at the scene. Many of the recommended doses or targeted therapeutic levels are higher than referenced in the literature and based upon expert opinions at nyph. 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. A study with sage547 for superrefractory status epilepticus. A week previously, he had presented to the outside hospital with fever 102. The treatment and prognosis of refractory and super. 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. The treatment and prognosis of refractory and superrefractory. Efficacy of ketamine in refractory convulsive status. This is the first report of anakinra for treatment of a child with superrefractory status epilepticus secondary to fires.
The following free resources have additional background information on this topic. A survival case of superrefractory status epilepticus due to. Sage547 and superrefractory status epilepticus youtube. Superrefractory status epilepticusstatus epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis a medical emergency.
We report a case of antigadassociated limbic encephalitis, presenting with super refractory status epilepticus. Apr 21, 2016 andrew cole, md of massachusetts general hospital and harvard medical school explains super refractory status epilepticus. Generalized convulsive status epilepticus emcrit project. Evaluate therapeutic strategies for superrefractory 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. 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. Superrefractory status epilepticus explained youtube. Andrew cole, md of massachusetts general hospital and harvard medical school talks about the recent data showing the efficacy of sage547. Superrefractory status epilepticus srse represent a serious neurological condition in paediatric intensive care units.
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. The treatment of superrefractory status epilepticus. Superrefractory status epilepticus is defined as status epilepticus. 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. The term superrefractory status epilepticus srse refers to a re fractory episode continuing under general anesthesia for more than 24 h.
There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for rcse, which. It is an uncommon but important clinical problem with high mortality and morbidity rates. Treatment of superrefractory status epilepticus springerlink. The search mainly resulted in case reports of various pharmacologic and nonpharmacologic treatments. Jun 23, 2015 a study with sage547 for super refractory status epilepticus the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. It has recently presented in an unclear pattern, and thus there are various challenges in its management in resource. Patients usually present with altered mental status, cognitive impairment and refractory seizures. This may be effective, even for super refractory status epilepticus 24453083, 30638692. Informed consent statement was obtained for this study. Superrefractory 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. To describe a case series of adult patients in the intensive care unit in super refractory status epilepticus srse. The surprising cause of a case of superrefractory pediatric status epilepticus. Evaluate therapeutic strategies for super refractory status epilepticus. Refractory and superrefractory status epilepticusan update.
Although constituting a minority of cases of status epilepticus. The treatment of superrefractory status epilepticus neurology. Newonset refractory status epilepticus norse is a recently coined term for refractory status epilepticus where. The treatment of superrefractory status epilepticus medscape. Distinguish gaps in the literature related to optimal status epilepticus treatment. Most of the causes of rse can be identified within 2472 hours of presentation, as it commonly due to an obvious acute brain injury stroke. This expanded edition represents the state of the art and captures many changes in our understanding of status epilepticus over the past decade. Novy and rossetti, 2010, appropriate therapy of these cases is poorly studied. This is extremely safe the riskbenefit ratio is arguably superior to most antiepileptic agents. Nutritional ketosis be done in patients with typei diabetes, although is more complicated and requires closer monitoring. Refractory and superrefractory status epilepticus in adults. Pediatric refractory and superrefractory status epilepticus. Ketogenic diet for adults in superrefractory 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.
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. Superrefractory status epilepticus pdf free download. Management of superrefractory status epilepticus with. Superrefractory status epilepticus srse is a devastating neurological condition with limited treatment options.
Pdf consensus protocol for the treatment of superrefractory. Andrew cole, md of massachusetts general hospital and harvard medical school explains superrefractory status epilepticus. Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. Superrefractory status epilepticus srse is defined as an epileptic status that. Anakinra is a recombinant version of the human interleukin1 receptor antagonist used to treat autoinflammatory disorders. Refractory and super refractory status epilepticus in adults. With the exception of anaesthetic coma, which is not sustainable, and the ketogenic diet in some patients 2, 3. Treatment of refractory and superrefractory status epilepticus ncbi. To summarize the available evidence related to pediatric refractory status epilepticus rse and superrefractory status epilepticus srse, with emphasis on epidemiology, etiologies, therapeutic approaches, and clinical outcomes. Super refractory status epilepticus the scale of the problem although relatively rare they are increasingly seen in specialised neurointensive care units and may take up bed space for many months morbidity and mortality is high due to the general complications of icu recovery is variable and therefore discussions regarding futility. Pdf the treatment of superrefractory status epilepticus. Status epilepticus that persists despite administration of at least 2 appropriately selected and dosed parenteral medications including a benzodiazepine is termed refractory status epilepticus rse. 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. Evaluate factors that may affect treatment success in patients with status epilepticus.
Ideally, a free phenytoin level may be checked, targeting a level of 23. We present a case of superrefractory status epilepticus srse in a previously healthy 38yearold righthanded man who initially presented at an outside hospital after a car accident. Superrefractory status epilepticus and febrile infection. Common intravenous agents such as diazepam, lorazepam, midazolam, and phenytoin used to treat rse have frequent problems with toxicity or efficacy 35. Superrefractory status epilepticus is defined as status epilepticus that continues or recurs 24h or more after. The success rate of each of the following agents, ketamine, inhaled. Srse is defined as status epilepticus that continues 24 h or more after the onset of anesthesia, including those cases in which the. There is ongoing serious damage to the neuraxis, in such cases, if seizures continue.