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When Status Epilepticus Does Not Respond to First Treatment 

When Status Epilepticus Does Not Respond to First Treatment
Chapter:
When Status Epilepticus Does Not Respond to First Treatment
Source:
Neurocritical Care (2 ed.)
Author(s):

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate

DOI:
10.1093/med/9780190602659.003.0016

Many seizures stop with treatment with benzodiazepines and fosphenytoin, but what if seizures return? Seizures become more resistant to antiepileptics over time, and prolonged status epilepticus can produce irreversible brain damage. What are then the available treatment choices? There is no shortage of treatment algorithms; this chapter presents the authors’ preferred approaches to treatment-refractory seizures. Generally, it is best to use a treatment protocol and to decisively progress from step to step. It is also important to make sure the right drugs and the right doses are being used. These are discussed in this chapter. Continuous electroencephalographic monitoring can be used to intubate the patient for continuous drug infusion. In the most recalcitrant cases, inhaled gases, such as isoflurane, and moderate hypothermia may be valuable therapeutic alternatives.

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