Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus

Sarah Nelson, Panayiotis N. Varelas

Research output: Contribution to journalReview article

Abstract

Purpose of Review: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. Recent Findings: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. 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. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. Summary: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities.

Original languageEnglish (US)
Pages (from-to)1683-1707
Number of pages25
JournalCONTINUUM Lifelong Learning in Neurology
Volume24
Issue number6
DOIs
StatePublished - Dec 1 2018

Fingerprint

Status Epilepticus
etiracetam
Ketogenic Diet
Nervous System Trauma
Induced Hypothermia
Transcranial Magnetic Stimulation

ASJC Scopus subject areas

  • Clinical Neurology
  • Genetics(clinical)

Cite this

Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus. / Nelson, Sarah; Varelas, Panayiotis N.

In: CONTINUUM Lifelong Learning in Neurology, Vol. 24, No. 6, 01.12.2018, p. 1683-1707.

Research output: Contribution to journalReview article

@article{a26d4a9a62c64a018d2546e80c9a8614,
title = "Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus",
abstract = "Purpose of Review: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. Recent Findings: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. 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. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. Summary: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities.",
author = "Sarah Nelson and Varelas, {Panayiotis N.}",
year = "2018",
month = "12",
day = "1",
doi = "10.1212/CON.0000000000000668",
language = "English (US)",
volume = "24",
pages = "1683--1707",
journal = "CONTINUUM Lifelong Learning in Neurology",
issn = "1080-2371",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Status Epilepticus, Refractory Status Epilepticus, and Super-refractory Status Epilepticus

AU - Nelson, Sarah

AU - Varelas, Panayiotis N.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Purpose of Review: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. Recent Findings: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. 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. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. Summary: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities.

AB - Purpose of Review: Status epilepticus, refractory status epilepticus, and super-refractory status epilepticus can be life-threatening conditions. This article presents an overview of the three conditions and discusses their management and outcomes. Recent Findings: Status epilepticus was previously defined as lasting for 30 minutes or longer but now is more often defined as lasting 5 minutes or longer. 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. Management of patients with status epilepticus generally requires several studies, with EEG of utmost importance given the pathophysiologic changes that can occur during the course of status epilepticus. Status epilepticus is treated with benzodiazepines as first-line antiepileptic drugs, followed by phenytoin, valproic acid, or levetiracetam. If status epilepticus does not resolve, these are followed by an IV anesthetic and then alternative therapies based on limited data/evidence, such as repetitive transcranial magnetic stimulation, therapeutic hypothermia, immunomodulatory agents, and the ketogenic diet. Scores have been developed to help predict the outcome of status epilepticus. Neurologic injury and outcome seem to worsen as the duration of status epilepticus increases, with outcomes generally worse in super-refractory status epilepticus compared to status epilepticus and sometimes also to refractory status epilepticus. Summary: Status epilepticus can be a life-threatening condition associated with multiple complications, including death, and can progress to refractory status epilepticus and super-refractory status epilepticus. More studies are needed to delineate the best management of these three entities.

UR - http://www.scopus.com/inward/record.url?scp=85059574423&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059574423&partnerID=8YFLogxK

U2 - 10.1212/CON.0000000000000668

DO - 10.1212/CON.0000000000000668

M3 - Review article

C2 - 30516601

AN - SCOPUS:85059574423

VL - 24

SP - 1683

EP - 1707

JO - CONTINUUM Lifelong Learning in Neurology

JF - CONTINUUM Lifelong Learning in Neurology

SN - 1080-2371

IS - 6

ER -