Malter Michael P, Neuneier Janina
Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
Neurol Res Pract. 2022 Aug 22;4(1):35. doi: 10.1186/s42466-022-00199-4.
Super-refractory status epilepticus (SRSE) represents the culmination of refractory status epilepticus (RSE) and carries a significant risk of poor neurological outcome and high mortality. RSE is not defined primarily by seizure duration, but by failure to respond to appropriate antiseizure treatment. SRSE is present when a RSE persists or recurs after more than 24 h of treatment with anesthetics. No evidence-based treatment algorithms can be provided for SRSE. Therefore, we propose a pragmatic standard operating procedure (SOP) for the management of SRSE that addresses the existing uncertainties in the treatment of SRSE and provides options for resolution and decision-making.
First, we recommend the assessment of persistent seizure activity and the evaluation of differential diagnoses to confirm correct diagnosis. Relevant differential diagnoses include psychogenic non-epileptic seizures, hypoxic, metabolic, or toxic encephalopathies, and tetanus. During SE or in severe encephalopathies, a so-called electroclinical ictal-interictal continuum may occur, which denotes an intermediate stage that cannot be defined with certainty as ictal or interictal by EEG and should not lead to harmful overtreatment. Because both prognosis and specific treatment options depend crucially on the etiology of SRSE, the etiological evaluation should be performed rapidly. When SRSE is confirmed, various pharmacological and non-pharmacological treatment options are available.
We provide a pragmatical SOP for adult people with SRSE.
超难治性癫痫持续状态（SRSE）是难治性癫痫持续状态（RSE）的最终阶段，具有神经功能预后不良和高死亡率的重大风险。RSE的定义主要不是基于癫痫发作持续时间，而是基于对适当的抗癫痫治疗无反应。当RSE在使用麻醉剂治疗超过24小时后持续或复发时，即存在SRSE。目前尚无针对SRSE的循证治疗方案。因此，我们提出一种实用的SRSE管理标准操作程序（SOP），以解决SRSE治疗中存在的不确定性，并提供解决和决策的选项。
首先，我们建议评估持续性癫痫发作活动并评估鉴别诊断以确认正确诊断。相关的鉴别诊断包括精神性非癫痫性发作、缺氧性、代谢性或中毒性脑病以及破伤风。在癫痫持续状态（SE）期间或严重脑病中，可能会出现所谓的电临床发作期-发作间期连续体，这表示一个中间阶段，脑电图无法明确界定为发作期或发作间期，且不应导致有害的过度治疗。由于预后和具体治疗方案都严重取决于SRSE的病因，因此应迅速进行病因评估。确诊SRSE后，有多种药物和非药物治疗选择。
我们为患有SRSE的成年人提供了一种实用的SOP。
