Super-refractory Status Epilepticus (SRSE) is

A CRITICAL PUZZLE OF

CLINICAL COMPLEXITY1-3

SRSE is a complex neurological crisis

Super-refractory status epilepticus (SRSE) is a life-threatening form of status epilepticus (SE) that continues or recurs for >24 hours despite multiple therapeutic interventions (first-, second-, and third-line agents).3,4

The burden of disease is high5 and evidence-based treatment options are limited.3,4

UNDERSTAND SRSE arrow

THE OUTCOMES
CAN BE POOR

The rapid diagnosis and termination of seizure progression to SRSE is crucial to minimize mortality, significant long-term morbidity, and healthcare resource utilization.4,5 Outcomes worsen with longer duration of status epilepticus,6 including risk of neuronal death,6-8 neuronal injury,6-8 and alteration of neuronal networks.3,4

EXPLORE SRSE CAUSES arrow

Mortality in
SRSE is high and
estimated to be between

~35%AND40%.1,9

Approximately

18%-35%

of patients with SRSE
return to baseline.1,9

THE BURDEN IS DEVASTATING

In addition to the physical burden to the patient, SRSE places an emotional burden on the patient’s family and caregivers. Managing a SRSE patient may also have significant financial impact on the hospital system.5

In a recent study using 2012 data from the Premier Hospital Database covering hospital discharges in the US*5:

Physical

9.3 Days: Mean length of SRSE stay in the intensive care unit (ICU)5

Financial

$51,247: Mean cost of SRSE hospitalization,5 compared to $18,963 for ischemic stroke10

Emotional

Family/Caregivers must make care decisions based on perception of the patient’s wishes in absence of a healthcare directive

VIEW CLINICAL PROGRESSION TO SRSE arrow

*The Premier Hospital Database was utilized to estimate the number of SRSE cases based on hospital discharges during 2012. Discharges were classified as SRSE cases based on an algorithm using seizure-related International Classification of Diseases-9 (ICD-9) codes, ICU length of stay (LOS), and treatment protocols (e.g., benzodiazepines, antiepileptic drugs [AEDs], and ventilator use). Secondary analyses were conducted using more restricted algorithms for SRSE. The study was sponsored by Sage Therapeutics, Inc.5

References:

  1. Delaj L, Novy J, Ryvlin P, Marchi NA, Rossetti AO. Refractory and super-refractory status epilepticus in adults: a 9-year cohort study. Acta Neurol Scand. 2017;135(1):92-99.
  2. Bayerlee A, Ganeshalingam N, Kurczewski L, Brophy GM. Treatment of super-refractory status epilepticus. Curr Neurol Neurosci Rep. 2015;15(10):66.
  3. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011;134(10):2802-2818.
  4. Hocker S, Tatum WO, LaRoche S, Freeman WD. Refractory and super-refractory status epilepticus – an update. Curr Neurol Neurosci Rep. 2014;14(6):452.
  5. Beg JM, Anderson TD, Francis K, et al. Burden of illness for super-refractory status epilepticus patients. J Med Econ. 2017;10(1):45-53.
  6. Scholtes FB, Renier WO, Meinardi H. Generalized convulsive status epilepticus: causes, therapy, and outcome in 346 patients. Epilepsia. 1994;35(5):1104-1112.
  7. Payne T, Bleck TP. Status epilepticus. Crit Care Clin. 1997;13(1):17-38.
  8. Meldrum B. Excitotoxicity and epileptic brain damage. Epilepsy Res. 1991;55-56.
  9. Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012;135(Pt 8):2314-2328.
  10. Wang G, Zhang Z, Ayala C, Dunet DO, Fang J, George MG. Costs of hospitalization for stroke patients aged 18-64 years in the United States. J Stroke Cerebrovasc Dis. 2014;23(5):861-868.