Which clinical history findings are characteristic of refractory status epilepticus (SE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Refractory status epilepticus is defined as recurrent seizures in spite of treatment with two anticonvulsants (including a benzodiazepine); super-refractory status epilepticus is defined as recurrent seizures in spite of anticonvulsants and anaesthetic therapy beyond the 24-hour mark. [52] Mechanisms behind these two conditions are thought to involve internalization of GABA receptors and increase in the number of glutamate receptors on the cell surface, among other factors. Also at the cellular level, refractory and super-refractory status epilepticus is characterized by a change in the ion concentration surrounding the cell; mitochondrial dysfunction; changes in the vasculature and opening of the blood-brain barrier. [53] These changes, along with excitotoxicity (glutamatergic excess), contribute to cerebral injury with status epilepticus—and in particular, refractory and super-refractory status epilepticus.


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