Management of Super-Refractory Status Epilepticus (SRSE)
TL;DR Summary: A clinical report on the successful utilization of the ketogenic diet and continuous infusion anesthetics in resolving super-refractory status epilepticus.
Super-refractory status epilepticus (SRSE) is defined as status epilepticus that continues or recurs 24 hours or more after the administration of anesthetic therapy.
Clinical Presentation
A 45-year-old male with a history of post-traumatic epilepsy was admitted following multiple generalized tonic-clonic seizures that failed to respond to lorazepam and fosphenytoin.
Management Strategy
- First-line Anesthetics: Continuous infusions of propofol and midazolam were initiated, but burst-suppression on EEG could not be maintained without seizure recurrence.
- Adjunctive Treatment: A ketogenic diet (4:1 lipid-to-non-lipid ratio) was introduced via nasogastric tube on day 3.
- Outcome: The addition of ketosis led to a rapid decrease in epileptiform discharges, allowing for successful weaning of anesthetics by day 7 with no further clinical seizures.
Discussion & Comments