How Refractory is Super-Refractory Status Epilepticus- A Personal View!

The word, super-refectory is coined recently in status epilepticus (SE) when the seizures continue unabated for a day or more, despite rigorous management , leading to subsequent neuronal injury, most of the times and even death [1]. The SuperRefractory Status Epilepeticus is a rare but not uncommon type of ongoing seizure activity and the exact pathophysiology is still not yet studied well. This type of seizure activity is commonly encountered in intensive care units but the exact frequency is not yet known. There were many retrospective studies in the recent past, revealing approximately 15% of cases admitted with status epilepticus, became refractory and Holktamp [2] reported 20% of his patients with SE had recurrence of ongoing SE after even general anesthesia was withdrawn and in some other studies nearly 50% of the those requiring anesthesia became super refractory in the various settings. In the ideal management protocol of SE, in staged approach, seizures of less than 30 minutes (early SE).