A Practical Approach to Super Refractory Status Epilepticus in Pediatric Intensive Care Unit

Objective: In this study, we aimed to evaluate the demographic, clinical features, long-term electroencephalography (EEG) findings and treatment modalities of pediatric patients with super refractory status epilepticus (SRSE). Method: A retrospective, observational study was conducted in patients diagnosed as SRSE between 1 June 2018 and 30 May 2021 in the pediatric intensive care unit. Patients with SRSE between 1 month and 18 years of age who underwent continuous electroencephalogram (cEEG) monitoring were included in the study. Demographic data, clinical, and electroencephalographic characteristics were collected. Results: A total of 11 patients were included in the study. The median age of the patients was 31 months (IQR 8-72 months). Nine (81.8%) patients had symptomatic etiology. Of the symptomatic etiologies, 4 (36.3%) patients had acute symptomatic, 3 (27.2%) patients had remote symptomatic and 2 (18.2%) patients had progressive etiology. The most common etiology was immune-related. The median cEEG duration of the patients was 60 hours (IQR 52-72 hours). Midazolam infusion was given to 11 (100%) patients, ketamine infusion was given to 9 (81.8%) patients, thiopental infusion was given to 6 (54.5%) patients, and propofol infusion was given to 2 (18.1%) patients as coma induction treatment. Intravenous immunoglobulin, corticosteroid and plasmapheresis were administered to 3 (27.2%) patients with immune etiology. The overall mortality was 18.1%. Conclusion: SRSE is a neurological emergency with high mortality and morbidity. cEEG monitoring is very important in diagnosis and treatment. Immune etiology should be considered in long-lasting seizures, especially if they are resistant to anesthetics. The immunomodulatory therapy should be started.