Nonpharmacologic and Nontraditional Treatments for Status Epilepticus

Abstract

If first- and second-line antiepileptic drugs (AEDs) fail to control status epilepticus (SE), it is termed refractory status epilepticus (RSE), and the likelihood of additional interventions stopping seizures diminishes dramatically. Both morbidity and mortality increase with longer duration of status epilepticus. One retrospective study of 47 RSE patients reported 23 % mortality and only 31 % returning to baseline [1, 2]. When RSE persists despite aggressive intervention with an anesthetic agent for 24 h or more, it is termed super-refractory status epilepticus (SRSE), and mortality rates are reported to be 30–50 % [1]. No prospective, double-blinded studies exist to direct management of RSE or SRSE. Nonpharmacologic and nontraditional treatments for status epilepticus are typically reserved for these types of cases, perhaps following several days of failed attempts at controlling seizures using a combination of antiepileptic drugs and general anesthetics. These treatment options can include hypothermia, neurostimulation, ketogenic dietary treatment, immunomodulation, and resective surgery (also see Chap. 32on investigational treatments of RSE).