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What is Refractory Status Epilepticus?

What is Refractory Status Epilepticus?

Refractory status epilepticus falls under the status epilepticus category where the patient continues to show the epilepticus even while continuing the treatment using benzodiazepines and antiepileptic medicines. It is likewise necessary to attend to the refractory status epilepticus promptly to prevent mortality. However, limited evidence supports to a specific treatment that helps in curing the status is unavailable.

Neurologists and scientists predict that age and etiology are the primary independent outcome. Additionally, recommendations for adults based on the limited evidence suggests that refractory status epilepticus treatment requires tailored clinical situation, which in turn helps in minimizing intensive care unit -related complications and focal status epilepticus without significant impairment of consciousness.

Occurrence of Refractory Status Epilepticus

The occurrence of refractory status epilepticus is on a scale of 40/100,000 people and is the second frequent neurological emergency which leads to mortality. Irrespective of time, persisting status epilepticus administered with benzodiazepines and at least one antiepileptic drug turns into refractory status epilepticus. The change occurs at least for 43% of patients suffering from status epilepticus.

Reason Behind the Occurrence of Refractory Status Epilepticus

Although the prospect of study estimates about the patients turning from status epilepticus into refractory status epilepticus is lower in proportions than ICU-based assessments, association with fatal underlying reasons such as massive stroke, rapidly progressing primary brain tumors, encephalitis, and severe impairment of consciousness also leads to the development of refractory status epilepticus.

Refractory Status Epilepticus Mortality Rate

In comparison to the standard status epilepticus, refractory status epilepticus is three times higher standing at 39%. A significant factor that one should remember here is that most of the fatalities occurring at this stage are not due to the persisting status epilepticus but instead due to the underlying clinical problems. Because of this, doctors are considering age, underlying issues, and symptoms experienced by a patient to identify the cause.

The risk of occurrence of epilepsy post the incident of refractory status epilepticus is three times higher when compared with the first symptomatic seizure.

Early Treatment for Refractory Status Epilepticus

Given the danger related with the refractory status epilepticus, there is a necessity to attend to it in a timely fashion with effective pharmacology treatment. Apart from this, several cases and studies displayed that the therapy becomes least effective when the refractory status epilepticus turns into a prolonged state. It was possible to control non-convulsive status epilepticus by first medication in 15% of cases. Additionally, the second and third agent was also effective in less than 10% of patients in both non-convulsive and overt convulsive status epilepticus.

Basic Principles

The fundamental principle includes treating the patient suffering from refractory status epilepticus to avoid complications and gain control of seizures. It is necessary to omit imitators, as it becomes difficult to diagnose after the patient enters the pharmacological coma. Sometimes, the patients show tremors, movement disorders, and focal dystonias.

The first steps of treatment for refractory status epilepticus include finding the cure in parallel with diagnostic procedures. Controlling the seizures becomes the top priority after the doctor attends to both the pulmonary and cardiac function. The process then follows intravenous administration in a sequence manner consisting of benzodiazepines, classical and the elliptical drug, and general anesthetic. The sequence of injecting the drug controls status epilepticus and provides more extended term coverage.

As such treatments are available only in hospitals, when an individual is suffering from refractory status epilepticus attack, using lorazepam initially will provide relief to the patient. The use of the protocol available facilitates smooth interplay for care providers such as neurologists, paramedics, and the ICU team. The aggressiveness of the therapy relies on the severity of refractory status epilepticus.


  1. “Status Epilepticus and Refractory Status Epilepticus: Definitions and Treatment” – Epilepsy Foundation. https://www.epilepsy.com/learn/challenges-epilepsy/seizure-emergencies/status-epilepticus-and-refractory-status-epilepticus

  2. “Refractory Status Epilepticus” – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/complex-partial-seizure/symptoms-causes/syc-20371283

  3. “Refractory status epilepticus: Initial treatment and prediction of outcome” – UpToDate. https://www.uptodate.com/contents/refractory-status-epilepticus-initial-treatment-and-prediction-of-outcome

  4. “Status Epilepticus” – American Epilepsy Society. https://www.aesnet.org/clinical_resources/status_epilepticus

  5. “Refractory Status Epilepticus” – Medscape. https://emedicine.medscape.com/article/1184193-overview

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Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 10, 2023

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