Benzodiazepine-refractory status epilepticus: A narrative review.

Area of Science:

• Neurology
• Emergency Medicine

Background:

• Status epilepticus (SE) presents a significant challenge in emergency departments, often refractory to initial benzodiazepine treatment.
• Prolonged seizures in SE carry substantial risks of morbidity and mortality, necessitating effective management strategies.

Purpose of the Study:

• This review evaluates management strategies for benzodiazepine-refractory SE.
• It highlights potential underlying causes and emphasizes timely therapeutic interventions.

Main Methods:

• The review synthesizes current literature on SE management.
• It focuses on treatment escalation protocols and the role of various anti-seizure medications (ASMs).

Main Results:

• Up to 40% of SE cases may not respond to benzodiazepines, indicating refractory SE.
• Identifying and reversing underlying etiologies (endocrine, metabolic, infectious, etc.) is crucial for seizure termination.

Conclusions:

• Early and aggressive treatment of SE is essential for neurological preservation.
• Clinicians must be prepared to use second- and third-line ASMs and consider continuous EEG monitoring for refractory cases.