Abstract
The treatment of super-refractory status epilepticus (SRSE) and prolonged SRSE rests
on urgent seizure control to minimize excitotoxic cerebral damage, other forms of
neurologic damage, and multiple medical complications. To date no randomized controlled
trials or clear-cut guidelines are available for the management of SRSE. We reported
the case of a 10-year-old previously healthy male child patient who presented with
a febrile illness and new onset prolonged SRSE that became refractory to multiple
antiseizure medications (ASMs). Coma induction with anesthetic agents, 14 ASMs, ketogenic
diet, immunotherapy failed to completely control the SRSE in our patient. On day 22,
clinical and electroencephalographic seizure control was achieved with isoflurane
inhalation anesthesia, which was continued for 3 weeks but was unable to be weaned.
From day 57 onwards, electroconvulsive therapy was administered (total 14 sessions
that resulted in complete control of seizures). He was discharged on the 80th day.
Keywords
status epilepticus - super-refractory status epilepticus - electroconvulsive therapy
- ketamine - isoflurane - FIRES
