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

Neurol Clin

Department of Neurology, University of Lausanne, Lausanne, Switzerland. Electronic address:

Published: February 2025

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.

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http://dx.doi.org/10.1016/j.ncl.2024.07.002DOI Listing

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