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What 3rd-line continuous intravenous (IV) anesthetic agent is indicated for treatment of super-refractory status epilepticus (SRSE)?

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What 3rd-line continuous intravenous (IV) anesthetic agent is indicated for treatment of super-refractory status epilepticus (SRSE)?

The correct answer is that there are no 3rd-line continuous IV anesthetic agents for SRSE.

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SRSE Management Guidelines

Hear more about SRSE management from Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM, FNCS

Currently, there are no FDA-approved therapies or evidence-based guidelines for the treatment of SRSE.1,2 The Neurocritical Care Society Guidelines for the Evaluation and Management of Status Epilepticus, however, suggest that midazolam, propofol, and pentobarbital are most often recommended for use as a continuous infusion in RSE, and in some countries, thiopental is used.3

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At what point in the management of a patient with status epilepticus (SE) should continuous EEG (cEEG) be ordered?

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At what point in the management of a patient with status epilepticus (SE) should continuous EEG (cEEG) be ordered?

The correct answer is within one hour of SE onset.

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cEEG & Burst vs Seizure Supression

Hear more about the value of cEEG from Stephan Mayer, MD, FCCM

According to the Neurocritical Care Society Guidelines for the Evaluation and Management of Status Epilepticus, continuous EEG (cEEG) should be ordered within one hour of SE onset if ongoing seizures are suspected.3

Expert opinion also states that cEEG should be ordered immediately, as it is critical to detect subclinical status to inform treatment.3

References:

  1. 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.
  2. Hocker S, Tatum WO, LaRoche S, Freeman WD. Refractory and super-refractory status epilepticus–an update. Curr Neurol Neurosci Rep. 2014;14:452.
  3. Brophy GM, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23.