Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study
Pediatric Critical Care Medicine (12/21) Vol. 22, No. 12, p. e613 DOI: 10.1097/PCC.0000000000002786
Vasquez, Alejandra; Farias-Moeller, Raquel; Sánchez-Fernández, Iván; et al.
Patients with super-refractory status epilepticus experienced delayed initiation of nonbenzodiazepine antiseizure medication, increased medical complications and mortality, and lower return to neurologic baseline compared with individuals with nonsuper-refractory status epilepticus, according to new research. The retrospective study, conducted by the Pediatric Status Epilepticus Research Group, sought to characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients. The researchers used prospectively collected data from 17 academic hospitals in the United States between June 2011 and January 2019. They identified 281 patients, with a median age of 4.1 years, including 31 with super-refractory status epilepticus. Overall, the super-refractory status epilepticus patients had delayed initiation of first nonbenzodiazepine-antiseizure medication compared with the nonsuper-refractory status epilepticus group, at 149 minutes vs. 62 minutes; of continuous infusion, at 495 min. vs. 150 min.; and prolonged seizure duration, 120 hours vs. 3 hours. In addition, the super-refractory group had a longer length of intensive care unit stay, more medical complications, lower return to baseline function, and higher mortality. Resolution of status epilepticus within the super-refractory group was achieved with one continuous infusion in 48.4% of the patients (15 of 31), two in 32.3% (10), and three or more in 19.4% (6). Midazolam was the first choice treatment for all but one of the super-refractory status epilepticus patients, and more than half (54.8%) underwent further treatment. The authors note, "Treatment approaches following the first continuous infusion were heterogeneous, reflecting limited information to guide clinical decision-making in super-refractory status epilepticus."