Treatment of Refractory Status Epilepticus: Literature Review and a Proposed Protocol

摘要: Refractory status epilepticus describes continuing seizures despite adequate initial pharmacologic treatment. This situation is common in children, but few data are available to guide management. We review the literature related treatment and overall management of refractory epilepticus, including midazolam, pentobarbital, phenobarbital, propofol, inhaled anesthetics, ketamine, valproic acid, topiramate, levetiracetam, pyridoxine, corticosteroids, ketogenic diet, electroconvulsive therapy. Based on data, we present a sample algorithm that emphasizes need for rapid therapeutic intervention, employs consecutive medications with different mechanisms action, attempts minimize risk hypotension. The steps suggest using benzodiazepines phenytoin. Second levetiracetam or which exert hemodynamic adverse effects have multiple action. Additional strategies could be employed tertiary-care settings, such as coma induction guided by continuous electroencephalogram monitoring surgical options, also discussed.