Refractory status epilepticus.
OBJECTIVE
Refractory status epilepticus (RSE) has a high morbidity and mortality. There are currently no definitive data to guide both the optimal choice of therapy and treatment goals. This review focuses on RSE diagnosis and outcome and discusses both commonly used and anecdotal therapies for RSE.


RESULTS
The challenges in performing randomized controlled trials (RCTs) in neurocritical care and more specifically for the treatment of RSE are illustrated by the early termination of the first RCT of RSE due to low recruitment that compared propofol to barbiturates. Recent case series include the successful treatment of recurrent RSE with ketamine, intravenous lacosamide as an add-on treatment, the use of combination antiepileptics (phenytoin, levetiracetam, and pregabalin), and surgical treatments (vagal nerve and deep brain stimulation) for the control of RSE.


CONCLUSIONS
A number of different therapeutic options are available for the treatment of RSE but none have been shown to be superior to others at this point.
Division of Critical Care Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
Andres
A
Fernandez
Jan
J
Claassen
D000927:Anticonvulsants / Q000627:therapeutic use*; D001463:Barbiturates / Q000627:therapeutic use*; D003422:Critical Care; D055423:Diet, Ketogenic; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D008297:Male; D015742:Propofol / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D016019:Survival Analysis; D016896:Treatment Outcome
D000927:Anticonvulsants; D001463:Barbiturates; D015742:Propofol