Abstract
Status epilepticus (SE) is the most severe presentation of epilepsy. Currently, SE
is defined according to 2 sequential time frames: time 1, after which it is unlikely
that the seizure will resolve spontaneously, therefore requiring the initiation of
therapy; and time 2, when long-term consequences become more likely. For convulsive
SE, these time frames are well defined: 5 minutes for time 1 and 30 minutes for time
2. “Time is brain” in the treatment of SE, as delays in diagnosis and treatment are
associated with worse outcomes. After clinical stabilization, the first step is the
administration of intravenous (IV) benzodiazepines. Rapid initiation of treatment
and use of appropriate dosing are more important than the selection of a specific
benzodiazepine. Following this, treatment continues with the use of an IV antiseizure
medication (ASM). In Brazil, the recommended options available are phenytoin and levetiracetam.
Status epilepticus is considered refractory to treatment if seizures persist after
the administration of benzodiazepines and IV ASM. The cornerstone of this stage is
the induction of therapeutic coma using IV anesthetic drugs (IVADs), although evidence
is limited regarding the choice among midazolam, propofol, or barbiturates. Super-refractory
SE is defined when seizures persist despite continuous infusion of IVADs or recur
after these drugs are tapered. There is very limited data regarding the treatment
of super-refractory SE. In the absence of randomized controlled trials, treatment
should be guided by the physician's experience, clinical judgment, and established
therapeutic options from previous reports.
Keywords
Status Epilepticus - Refractory - Super-Refractory - Antiseizure Medications
Bibliographical Record
Luis Otavio Caboclo. Treatment of convulsive status epilepticus in Brazil: a review.
Arq Neuropsiquiatr 2025; 83: s00451801872.
DOI: 10.1055/s-0045-1801872
