What is SRSE?
SRSE is a special form of status epilepticus. The full form of SRSE is Super Refractory Status Epilepticus. SRSE is a condition where a patient has continued form of status epilepticus despite any kind of medical drugs and other therapies to combat the seizures.
Who Are at Risk of Having SRSE?
Although the major cause of SRSE for different patients may be different, research show that some people are more prone to SRSE, compared to others-
- It has been found that children and elderly adults are rather more prone to SRSE compared to young or middle aged adults.
- If a person is diagnosed with Encephalitis, he is susceptible to SRSE.
- If a patient’s consciousness is severely impaired he is at risk of having SRSE.
What Happens To The Patient Who Is Suffering From SRSE?
When a patient is diagnosed with Status Epilepticus (SE), which include prolonged episodes of seizures (more than 5 minutes), he is given antiepileptic drugs. At times, it may happen so that the patient may not respond to the first and second line antiepileptic drugs. Such a case is diagnosed as Refractory Status Epilepticus (RSE). As a treatment procedure of such case, the patient is given antiepileptic drugs after medically inducing coma to the patient. Later, the doctor tries to wean the patient from the anaesthetics used to induce coma in order to check if the seizures have resolved. When the patient cannot successfully be weaned off the coma without further seizures, he is said to be suffering from SRSE.
What are the Causes of SRSE?
There can be various underlying causes for SRSE ranging from brain infection to intracranial bleeding and toxic infection. Some of the causes include-
- It is seen that in most of the cases, when a patient suffers from more than one episode of status epilepticus, the processes used to terminate the seizures do not prove to be adequate.
- From the neurophysiologic context, one recent discovery reveals that receptors on the surface of the axons move in different directions along the axon membrane.
- Such irregular movement leads to an increased receptor trafficking when the patient encounters status epilepticus.
- This reduces the number of a type of neurotransmitter called the GABA receptors in the cells affected due to the seizure.
- It should be noted that the GABA receptors work as a form of inhibitory neurotransmitters. This is why the reduction of them does not allow the seizures to stop making them persistent and continuous.
- It has also been found that mitochondrial insufficiency can be one reason contributing to the failure of seizure termination.
- Recent research leads to the importance of understanding the fact that an inflammatory disease may also trigger SRSE. There is a barrier which separates the brain from blood which plays a major role terminating the seizures. If the blood-brain barrier leaks due to inflammation of the brain, it may lead to higher potassium levels which excite the neurons and thus to terminate the seizures become a difficult task.
- Genetic studies show that genes pay an important role in framing a person all together. For some people, due to reasons of genetic mutation of a particular gene, antiepileptic drugs do not work well. Such a gene becomes resistant to the drugs and this leads to SRSE.
- It should also be noted that numerous changes occur at a genetic level, from the onset of status epilepticus, which can contribute to SRSE.
- Some researches point out that, status epilepticus occurs due to failed synchronization of seizure activity. This improper activity may prevent seizures from termination leading to SRSE.