Subscribe to RSS
Successful Use of Inhalational Anesthesia and Electroconvulsive Therapy in a Child with New Onset Prolonged Super-Refractory Status EpilepticusFunding None.
The treatment of super-refractory status epilepticus (SRSE) and prolonged SRSE rests on urgent seizure control to minimize excitotoxic cerebral damage, other forms of neurologic damage, and multiple medical complications. To date no randomized controlled trials or clear-cut guidelines are available for the management of SRSE. We reported the case of a 10-year-old previously healthy male child patient who presented with a febrile illness and new onset prolonged SRSE that became refractory to multiple antiseizure medications (ASMs). Coma induction with anesthetic agents, 14 ASMs, ketogenic diet, immunotherapy failed to completely control the SRSE in our patient. On day 22, clinical and electroencephalographic seizure control was achieved with isoflurane inhalation anesthesia, which was continued for 3 weeks but was unable to be weaned. From day 57 onwards, electroconvulsive therapy was administered (total 14 sessions that resulted in complete control of seizures). He was discharged on the 80th day.
Keywordsstatus epilepticus - super-refractory status epilepticus - electroconvulsive therapy - ketamine - isoflurane - FIRES
Received: 14 July 2021
Accepted: 14 October 2021
02 December 2021 (online)
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Shorvon S. Super-refractory status epilepticus: an approach to therapy in this difficult clinical situation. Epilepsia 2011; 52 (Suppl. 08) 53-56
- 2 Kilbride RD, Reynolds AS, Szaflarski JP, Hirsch LJ. Clinical outcomes following prolonged refractory status epilepticus (PRSE). Neurocrit Care 2013; 18 (03) 374-385
- 3 Arayakarnkul P, Chomtho K. Treatment options in pediatric super-refractory status epilepticus. Brain Dev 2019; 41 (04) 359-366
- 4 Vasquez A, Farias-Moeller R, Tatum W. Pediatric refractory and super-refractory status epilepticus. Seizure 2019; 68: 62-71
- 5 Griesemer DA, Kellner CH, Beale MD, Smith GM. Electroconvulsive therapy for treatment of intractable seizures. Initial findings in two children. Neurology 1997; 49 (05) 1389-1392
- 6 Shin HW, O'Donovan CA, Boggs JG. et al. Successful ECT treatment for medically refractory nonconvulsive status epilepticus in pediatric patient. Seizure 2011; 20 (05) 433-436
- 7 Rai S, Drislane FW. Treatment of refractory and super-refractory status epilepticus. Neurotherapeutics 2018; 15 (03) 697-712
- 8 Gomes D, Pimentel J, Bentes C. et al. Consensus protocol for the treatment of super-refractory status epilepticus. Acta Med Port 2018; 31 (10) 598-605
- 9 Kofke WA, Young RS, Davis P. et al. Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology 1989; 71 (05) 653-659
- 10 Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol 2004; 61 (08) 1254-1259
- 11 Trinka E, Brigo F. Neurostimulation in the treatment of refractory and super-refractory status epilepticus. Epilepsy Behav 2019; 101 (Pt B): 106551 DOI: 10.1016/j.yebeh.2019.106551.
- 12 Kamel H, Cornes SB, Hegde M, Hall SE, Josephson SA. Electroconvulsive therapy for refractory status epilepticus: a case series. Neurocrit Care 2010; 12 (02) 204-210
- 13 Lambrecq V, Villéga F, Marchal C. et al. Refractory status epilepticus: electroconvulsive therapy as a possible therapeutic strategy. Seizure 2012; 21 (09) 661-664
- 14 Mirás Veiga A, Moreno DC, Menéndez AI. et al. Effectiveness of electroconvulsive therapy for refractory status epilepticus in febrile infection-related epilepsy syndrome. Neuropediatrics 2017; 48 (01) 45-48
- 15 García-López B, Gómez-Menéndez AI, Vázquez-Sánchez F. et al. Electroconvulsive therapy in super refractory status epilepticus: case series with a defined protocol. Int J Environ Res Public Health 2020; 17 (11) 4023-4033
- 16 Zeiler FA, Matuszczak M, Teitelbaum J, Gillman LM, Kazina CJ. Electroconvulsive therapy for refractory status epilepticus: a systematic review. Seizure 2016; 35: 23-32