Prolonged Coma From Refractory Status Epilepticus

Abstract

Few evidence-based data exist to guide management of RSE. Our case emphasizes the need for continuous aggressive therapy when neuroimaging remains normal.

Management of refractory status epilepticus in adults: still more questions than answers

“…Although long-lasting RSE generally heralds a poor prognosis, some exactions exists: patients suffering from RSE from several days, weeks, or even months may at times recover with a good functional outcome 15, 100, 116–118 . Certainly in some patients, most often those with an infectious or autoimmune etiology, the underlying disease process subsides after some time, allowing awakening of the patient without repetitive seizures.…”

“…Certainly in some patients, most often those with an infectious or autoimmune etiology, the underlying disease process subsides after some time, allowing awakening of the patient without repetitive seizures. It appears therefore advisable not to stop supportive treatment, including repetitive courses of anesthetics if needed, just because of protracted treatment duration, if neuroimaging remains normal, apart from minor signs of global atrophy 118 , and no underlying etiology heralding a catastrophic prognosis is identified (e.g., rapidly progressive brain tumors, paraneoplastic limbic encephalitis with disseminated primary cancer, prion disease). This especially applies to younger patients, who are usually able to tolerate the cardiovascular side effects of long-term anesthesia.…”

Reversible focal neurological deficits in systemic lupus erythematosus: Report of 2 cases and review of the literature

“…There are 6 major situations where there are reversible lesions in NP-SLE: 1) so-called reversible posterior leukoencephalopathy syndrome (RPLS), usually associated with very active SLE, hypertension, glomerulonephritis, and isolated generalized seizures (not epilepsy) [14][15][16], 2) reversible lesions associated with isolated seizures without hypertension, and especially with status epilepticus in SLE [17], 3) reversible edema associated with focal infarct [18], 4) reversible lesions of acute myelopathy, usually resulting in a reversible or irreversible cord or brain stem syndrome [18], 5) reversible leukoencephalopathy associated with immunosuppression that resolves with withdrawal of immunosuppression [19], 6) reversible brain lesions associated with TTP of cardiac lesions. It should pointed out that marked hypertension was observed in most patients with RPLS [16].…”

Treatment of Super-Refractory Status Epilepticus

“…Prolonged therapy is suggested in young patients with no premorbid state and self-limiting disease processes [11,12].…”