Super-Refractory Status Epilepticus Diagnosis, Management, and Prognostication: An International Survey Study

Area of Science:

• Neurology
• Critical Care Medicine
• Clinical Practice Guidelines

Background:

• Super-refractory status epilepticus (SRSE) lacks established guidelines for evaluation, management, and prognostication.
• Understanding current practice patterns is crucial for identifying trends and future research areas in SRSE care.

Purpose of the Study:

• To characterize current clinical practice patterns for the evaluation, management, and prognostication of super-refractory status epilepticus (SRSE).

Main Methods:

• An international, cross-sectional web-based survey of 209 clinicians managing SRSE.
• Data collected on diagnostics, management strategies (e.g., IV anesthetics, EEG targets), and prognostication approaches using vignettes.
• Descriptive statistics and logistic regression models were used to analyze responses.

Main Results:

• Significant variability observed in treatment preferences (e.g., midazolam, propofol, ketamine), EEG targets (burst suppression, seizure suppression), and therapy duration.
• Prognostication ability varied by clinician specialty and experience; factors like caseload and use of severity scores influenced predictions.
• Timing of futility determination and withdrawal of life-sustaining therapy recommendations showed bimodal distributions, linked to prognostic optimism.

Conclusions:

• Current evaluation and management of SRSE demonstrate considerable variability among clinicians.
• Prognostication in SRSE is influenced by clinician-specific factors and practice characteristics.
• The timing of prognostication is highly variable and correlates with clinician optimism.