Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 10 ( 2016 ) > List of Articles

REVIEW ARTICLE

Seizures - just the tip of the iceberg: Critical care management of super-refractory status epilepticus

Karen Lionel

Keywords : Critical care management, status epilepticus, super refractory

Citation Information : Lionel K. Seizures - just the tip of the iceberg: Critical care management of super-refractory status epilepticus. Indian J Crit Care Med 2016; 20 (10):587-592.

DOI: 10.4103/0972-5229.192047

License: CC BY-ND 3.0

Published Online: 00-10-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 h or more after the onset of anesthetic therapy, including those cases where SE recurs on the reduction or withdrawal of anesthesia. Although SRSE is a rare clinical problem, it is associated with high mortality and morbidity rates. This article reviews the treatment approaches and the systemic complications commonly encountered in patients with SRSE. As evident in our search of literature, therapy for SRSE and its complications have been based on clinical reports and expert opinions since there is a lack of controlled and randomized trials. Even though this complex condition starts as a neurological disorder, because of the associated systemic complications, it can be considered as a multisystem disorder requiring scrupulous attention and deliberate efforts to prevent, detect, and treat these systemic effects. We have critically reviewed the intensive care management for SRSE per se as well as its associated systemic complications. We believe that a good recovery can occur even after prolonged and severe SRSE as long as the systemic complications are detected early and managed appropriately.


PDF Share
  1. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: A critical review of available therapies and a clinical treatment protocol. Brain 2011;134(Pt 10):2802-18.
  2. Hauser WA. Status epilepticus: Epidemiologic considerations. Neurology 1990;40 5 Suppl 2:9-13.
  3. DeLorenzo RJ, Hauser WA, Towne AR, Boggs JG, Pellock JM, Penberthy L, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology 1996;46:1029-35.
  4. Coeytaux A, Jallon P, Galobardes B, Morabia A. Incidence of status epilepticus in French-speaking Switzerland: (EPISTAR). Neurology 2000;55:693-7.
  5. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: Frequency, risk factors, and impact on outcome. Arch Neurol 2002;59:205-10.
  6. Chen JW, Wasterlain CG. Status epilepticus: Pathophysiology and management in adults. Lancet Neurol 2006;5:246-56.
  7. Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain 2012;135(Pt 8):2314-28.
  8. Cooper AD, Britton JW, Rabinstein AA. Functional and cognitive outcome in prolonged refractory status epilepticus. Arch Neurol 2009;66:1505-9.
  9. Rossetti AO, Lowenstein DH. Management of refractory status epilepticus in adults: Still more questions than answers. Lancet Neurol 2011;10:922-30.
  10. Drislane FW, Lopez MR, Blum AS, Schomer DL. Detection and treatment of refractory status epilepticus in the intensive care unit. J Clin Neurophysiol 2008;25:181-6.
  11. Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: Effect of treatment aggressiveness on prognosis. Arch Neurol 2005;62:1698-702.
  12. Iyer VN, Hoel R, Rabinstein AA. Propofol infusion syndrome in patients with refractory status epilepticus: An 11-year clinical experience. Crit Care Med 2009;37:3024-30.
  13. Krishnamurthy KB, Drislane FW. Relapse and survival after barbiturate anesthetic treatment of refractory status epilepticus. Epilepsia 1996;37:863-7.
  14. Parviainen I, Uusaro A, Kälviäinen R, Kaukanen E, Mervaala E, Ruokonen E. High-dose thiopental in the treatment of refractory status epilepticus in intensive care unit. Neurology 2002;59:1249-51.
  15. Kramer AH. Early ketamine to treat refractory status epilepticus. Neurocrit Care 2012;16:299-305.
  16. Prüss H, Holtkamp M. Ketamine successfully terminates malignant status epilepticus. Epilepsy Res 2008;82:219-22.
  17. Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004;61:1254-9.
  18. Misra S, Koshy T. A review of the practice of sedation with inhalational anaesthetics in the intensive care unit with the AnaConDa® device. Indian J Anaesth 2012;56:518-23.
  19. Bleck TP. Management approaches to prolonged seizures and status epilepticus. Epilepsia 1999;40 Suppl 1:S59-63.
  20. Iannetti P, Spalice A, Parisi P. Calcium-channel blocker verapamil administration in prolonged and refractory status epilepticus. Epilepsia 2005;46:967-9.
  21. Eriksson K, Metsäranta P, Huhtala H, Auvinen A, Kuusela AL, Koivikko M. Treatment delay and the risk of prolonged status epilepticus. Neurology 2005;65:1316-8.
  22. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry 2005;76:534-9.
  23. Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care 2008;9:189-97.
  24. Kamel H, Cornes SB, Hegde M, Hall SE, Josephson SA. Electroconvulsive therapy for refractory status epilepticus: A case series. Neurocrit Care 2010;12:204-10.
  25. Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. VNS for refractory status epilepticus. Epilepsy Res 2015;112:100-13.
  26. Misawa S, Kuwabara S, Shibuya K, Mamada K, Hattori T. Low-frequency transcranial magnetic stimulation for epilepsia partialis continua due to cortical dysplasia. J Neurol Sci 2005;234:37-9.
  27. Lhatoo SD, Alexopoulos AV. The surgical treatment of status epilepticus. Epilepsia 2007;48 Suppl 8:61-5.
  28. Kossoff E. The fat is in the fire: Ketogenic diet for refractory status epilepticus. Epilepsy Curr 2011;11:88-9.
  29. François LL, Manel V, Rousselle C, David M. Ketogenic regime as anti-epileptic treatment: Its use in 29 epileptic children. Arch Pediatr 2003;10:300-6.
  30. Hocker S. Systemic complications of status epilepticus - An update. Epilepsy Behav 2015;49:83-7.
  31. Simon RP, Aminoff MJ, Benowitz NL. Changes in plasma catecholamines after tonic-clonic seizures. Neurology 1984;34:255-7.
  32. Walton NY. Systemic effects of generalized convulsive status epilepticus. Epilepsia 1993;34 Suppl 1:S54-8.
  33. Shimizu M, Kagawa A, Takano T, Masai H, Miwa Y. Neurogenic stunned myocardium associated with status epileptics and postictal catecholamine surge. Intern Med 2008;47:269-73.
  34. Vohra TT, Miller JB, Nicholas KS, Varelas PN, Harsh DM, Durkalski V, et al. Endotracheal intubation in patients treated for prehospital status epilepticus. Neurocrit Care 2015;23:33-43.
  35. Singhal PC, Chugh KS, Gulati DR. Myoglobinuria and renal failure after status epilepticus. Neurology 1978;28:200-1.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.