Therapeutic approaches for super-refractory status epilepticus: an update of the literature.

Abstract

Introduction: The prevention and treatment of super-refractory status epilepticus (SRSE) remains difficult. Rapid seizure termination and effective management of fatal complications are the keys to improving prognosis.

Areas covered: This review is based on the current literature related to SRSE published in the PubMed database from 2000-March 2025 using the keywords 'SRSE' and 'drug treatment.' The purpose of this article is to shed new light and perspective on the treatment of SRSE.

Expert opinion: SRSE treatment should first target the primary disease that causes SRSE. As the primary disease improves, the frequency of attacks gradually decreases. However, persistent epileptic seizures can cause brain damage and functional disorders, thereby altering the evolution of the primary disease. Therefore, the quick termination of epileptic seizures in patients and the proper management of fatal complications are important measures that can improve patient prognosis. Ketamine, a KD and combination therapy are the most common treatments. Although no consensus has been established, these treatments are generally successful. Neuromodulation, new antiepileptic drugs and surgery are also promising therapeutic areas. However, most reports include individual cases or case series, and thus these drugs and methods should be used with caution.