Nnsuper refractory status epilepticus pdf merger

Treatment of refractory and superrefractory status epilepticus. Pdf refractory and superrefractory status epilepticus. Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. Methods in the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent eeg. 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. Treatment of rse has not been studied in a prospective trial, and. Status epilepticus may occur in those with a history of epilepsy as well as those with an underlying problem of the brain. The treatment and prognosis of refractory and super. A definition and classification of status epilepticus report of the ilae task force on classification of status epilepticus. The concept of super refractory status and newer etiologies and therapeutic options are also discussed. Pdf refractory and superrefractory status epilepticusan. With the exception of anaesthetic coma, which is not sustainable, and the ketogenic diet in some patients 2, 3. It is likewise necessary to attend to the refractory status epilepticus promptly to prevent mortality. Superrefractory status epilepticus explained youtube.

Status epilepticus is a neurologic emergency and can progress to refractory status epilepticus and super refractory status epilepticus. 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. Superrefractory status epilepticus and febrile infection. 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. J k murthy convulsive status epilepticus api india 20 3. Guidelines for the evaluation and management of status. Gaps and opportunities in refractory status epilepticus. Refractory status epilepticus occurs in 1070% of adults. 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. 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. Refractory status epilepticus is defined as persistent seizures despite. Treatment of refractory and superrefractory status epilepticus ncbi.

Refractory status epilepticus is a potentially lifethreatening medical emergency. Md of massachusetts general hospital and harvard medical school explains super refractory status epilepticus. Tracy glauser, from the university of cincinnati, about new status epilepticus guidelines. 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. Because of the small numbers, there are no definitive studies regarding. Status epilepticus, refractory status epilepticus, and. How refractory is superrefractory status epilepticus a. Evolution of cerebral atrophy in a patient with super.

Treatment of refractory and superrefractory status. These underlying brain problems may include trauma, infections, or strokes among others. There are a variety of treatments used, almost entirely based on open observational studies or case reports. Status epilepticus is a lifethreatening medical emergency, particularly if treatment is delayed. Superrefractory status epilepticusstatus epilepticus that continues or recurs 24 hours or more after the onset of anesthetic therapyis. 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.

Many factors often combine to lower the patients seizure threshold. Management of refractory status epilepticus involves treatment of an. How refractory is super refractory status epilepticus a personal iew. Transitioning treatment from status epilepticus to super refractory status epilepticus david roy, pharmd pgy1 pharmacy resident. The article summarises the causes, effects, pathophysiology and treatment protocols for refractory status epilepticus. Cryptogenic new onset refractory status epilepticus norse. In status epilepticus seizures appear in close succession or dont stop. This case highlights the development and progression of generalized cerebral atrophy in super refractory status epilepticus. Several recent guidelines and consensus statements highlight the critical role of continuous eeg ceeg monitoring during prolonged treatment.

Newonset refractory status epilepticus norse and febrile. 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. In this episode of hallway conversations, editorinchief dr. 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. Ketogenic diet in 3 cases of childhood refractory status epilepticus. Refractory status epilepticus rse can be defined as status epilepticus that. Status epilepticus international league against epilepsy. It is a serious condition that requires prompt medical attention. The treatment of superrefractory 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.

Cole epilepsy service, department of neurology, acc 835, massachusetts general hospital, harvard medical school, boston, ma 02114, usa. 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. Apr 21, 2016 super refractory status epilepticus explained rare disease report. Randomized study of intravenous valproate and phenytoin in status epilepticus. The different electroclinical types of status epilepticus share eeg characteristics. Management of superrefractory status epilepticus with. Cryptogenic new onset refractory status epilepticus norse in adultsinfectious or not.

The term superrefractory status epilepticus was introduced during the londoninnsbruck colloquium on status epilepticus in 2011 and refers to status epilepticus that continues or. This is a pdf file of an unedited manuscript that has been. Electroencephalography is the gold standard for diagnosis. Superrefractory status epilepticus is defined as status epilepticus that continues or recurs 24h.

Refractory status epilepticus creighton university. 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. The term superrefractory status epilepticus srse refers to a re fractory episode continuing under general anesthesia for more than 24 h. The norse newonset refractory status epilepticus syndrome. Predictors of outcome in refractory status epilepticus. Some authorities have also defined rse on the basis of the duration of seizure for 1 or 2 hours. Neurologic outcome of postanoxic refractory status. Additionally gene expression within few minutes of seizures and lack of synchrony.

Generalized convulsive status epilepticus emcrit project. Refractory and superrefractory status epilepticus indian pediatrics. 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. Efns guideline on the management of status epilepticus. Management of refractory status epilepticus in adults. 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. References status epilepticus care guideline agarwal p, et al. Newonset refractory status epilepticus johns hopkins. However, limited evidence supports to a specific treatment that helps in curing. Management of patients with status epilepticus generally requires several. The treatment of superrefractory status epilepticus neurology.

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. The american epilepsy society guidelines published in. Treatment of rse has not been studied prospectively, and guidelines give a variety of options. Nicholas hirsch neuromedical intensive care unit the national hospital for neurology and neurosurgery queen square london state of the art meeting 2015 2. Immune therapies were used less frequently in cryptogenic cases, despite a comparable prevalence of inflammatory csf changes. Newonset refractory status epilepticus norse is a recently coined term for refractory status epilepticus where. It is an uncommon but important clinical problem with high mortality and morbidity rates.