1/11/2024 0 Comments Status epilepticus![]() Status epilepticus (SE) is an important neurological emergency, second only to stroke as a cause of admission to a neurological intensive care unit. Status epilepticus: Refractory and super-refractory. How to cite this URL: Dubey D, Kalita J, Misra UK. How to cite this article: Dubey D, Kalita J, Misra UK. Aggressive treatment is required in the intensive care units as the conditions have a 30–40% mortality. RSE and SRSE are serious neurological emergencies, the management protocols of which have recently been formalized. Keywords: Burst suppression, refractory status epilepticus, status epilepticus, Status epilepticus in India, super refractory status epilepticus There is a need to explore intravenous AEDs with safer cardiovascular and respiratory profile for the management of SE. The paucity of ICUs in developing countries limits the use of these management protocols. Recently, concerns have been raised on the safety of burst suppression in RSE and SRSE. In RSE patients, electroencephalogram (EEG) burst suppression with interburst interval of 2–20 s or even flat EEG has been tried. Most intravenous anesthetic drugs produce hypotension and respiratory suppression therefore, patients with RSE are managed in intensive care units (ICUs). Following benzodiazepines, the second line antiepileptic drugs include sodium valproate, phenytoin, levetiracetam, and anesthetic drugs such as midazolam, phenobarbital, and propofol. The treatment of RSE and SRSE is not evidence based. The etiology of RSE in developing countries is dominated by central nervous system (CNS) infections and head injury compared to stroke and drug withdrawal in the developed countries. In general, RSE occurs in patients with new-onset seizures rather than in patients with chronic epilepsy. RSE occurs in 23%–48% of the patients and SRSE in approximately 22% of the patients with SE. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Status epilepticus (SE) is an important neurological emergency.
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