Terminology for Nonstop Status Epilepticus
The term for status epilepticus that continues despite initial treatment with benzodiazepines and second-line antiseizure medications is "refractory status epilepticus," and if it persists for 24 hours or more after anesthetic therapy or recurs upon weaning anesthetics, it is termed "super-refractory status epilepticus." 1, 2
Definitions and Classification
Refractory Status Epilepticus (RSE):
- SE that persists despite adequate doses of benzodiazepines and at least one antiepileptic drug, regardless of time duration 1
- Occurs in 23-48% of patients with status epilepticus 1
- More commonly occurs in patients with new-onset seizures rather than those with chronic epilepsy 1
Super-Refractory Status Epilepticus (SRSE):
- SE that continues for 24 hours or more after initiation of anesthetic therapy 1, 2
- Also includes cases that recur when weaning the anesthetic agent 1
- Occurs in approximately 22% of patients with status epilepticus 1
- Associated with mortality approaching 40% 2
Related Terminology
Nonconvulsive Status Epilepticus:
- The term used to describe seizures where the primary manifestation is not motor in nature 3
- Includes absence status epilepticus and complex partial status epilepticus 3
- Cannot be diagnosed by clinical observation alone and requires EEG confirmation 4
Subtle Convulsive Status Epilepticus:
- Generalized convulsive status epilepticus that has evolved with continuing abnormal EEG discharges but minimal or absent convulsive movements 3
- Ongoing electrical seizure activity may cause cell injury even in the absence of convulsive movements 3
Clinical Significance
The distinction between these terms is critical for prognosis and treatment escalation: