Refractory and Super-Refractory Status Epilepticus: Therapeutic Options and Prognosis

Andrea O Rossetti

doi:10.1016/j.ncl.2024.07.002

Refractory and Super-Refractory Status Epilepticus: Therapeutic Options and Prognosis

Neurol Clin. 2025 Feb;43(1):15-30. doi: 10.1016/j.ncl.2024.07.002. Epub 2024 Oct 15.

Author

Andrea O Rossetti¹

Affiliation

¹ Department of Neurology, University of Lausanne, Lausanne, Switzerland. Electronic address: [email protected].

PMID: 39547738
DOI: 10.1016/j.ncl.2024.07.002

Abstract

In patients with status epilepticus (SE), the underlying biologic background represents the main prognostic variable. A swift application of a treatment protocol is recommended, including adequate doses of a benzodiazepine followed by an intravenous anti-seizure medicine. If refractory SE arises, general anesthetics should be used in generalized convulsive and non-convulsive SE in coma, while further non-sedating anti-seizure medications attempts are warranted in patients with focal forms. Ketogenic diet and/or ketamine in patients with super-refractory SE, and immunologic treatments for those with new-onset refractory SE/febrile-induced refractory epilepsy syndrome should be considered early. Pharmacologic treatment of SE after cardiac arrest should be oriented by the results of multimodal prognostication.

Keywords: Continuous electroencephalogram; General anesthetics; Ketogenic diet; Mortality; Outcome; Treatment.

Publication types

Review

MeSH terms

Anticonvulsants* / therapeutic use
Diet, Ketogenic / methods
Drug Resistant Epilepsy* / diagnosis
Drug Resistant Epilepsy* / diet therapy
Drug Resistant Epilepsy* / drug therapy
Drug Resistant Epilepsy* / etiology
Humans
Prognosis
Status Epilepticus* / diagnosis
Status Epilepticus* / diet therapy
Status Epilepticus* / drug therapy
Status Epilepticus* / etiology

Substances

Anticonvulsants