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Super-Refractory Status Epilepticus in Children: A Retrospective Cohort Study

By Currents Editor posted 01-06-2022 09:13


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."


Ita Muharram Sari, MD National Brain Center Prof. Dr. Mahar Mardjono Hospital (NBC) is the main referral hospital specializing in brain and nervous systems under the Ministry of Health Republic of Indonesia. As a center of excellence, NBC gives advanced clinical practice on neurological diseases, education, ...
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