Super-refractory status epilepticus in children: A retrospective cohort study

Alejandra Vasquez, Raquel Farias-Moeller, Iván Sánchez-Fernández, Nicholas S. Abend, Marta Amengual-Gual, Anne Anderson, Ravindra Arya, James N. Brenton, Jessica L. Carpenter, Kevin Chapman, Justice Clark, William D. Gaillard, Tracy Glauser, Joshua L. Goldstein, Howard P. Goodkin, Rejean M. Guerriero, Yi Chen Lai, Tiffani L. McDonough, Mohamad A. Mikati, Lindsey A. MorganEdward J. Novotny, Adam P. Ostendorf, Eric T. Payne, Katrina Peariso, Juan Piantino, James J. Riviello, Tristan T. Sands, Kumar Sannagowdara, Robert C. Tasker, Dmitry Tchapyjnikov, Alexis Topjian, Mark S. Wainwright, Angus Wilfong, Korwyn Williams, Tobias Loddenkemper

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


OBJECTIVES: To characterize the pediatric super-refractory status epilepticus population by describing treatment variability in super-refractory status epilepticus patients and comparing relevant clinical characteristics, including outcomes, between super-refractory status epilepticus, and nonsuper-refractory status epilepticus patients. DESIGN: Retrospective cohort study with prospectively collected data between June 2011 and January 2019. SETTING: Seventeen academic hospitals in the United States. PATIENTS: We included patients 1 month to 21 years old presenting with convulsive refractory status epilepticus. We defined super-refractory status epilepticus as continuous or intermittent seizures lasting greater than or equal to 24 hours following initiation of continuous infusion and divided the cohort into superrefractory status epilepticus and nonsuper-refractory status epilepticus groups. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We identified 281 patients (157 males) with a median age of 4.1 years (1.3-9.5 yr), including 31 super-refractory status epilepticus patients. Compared with nonsuper-refractory status epilepticus group, super-refractory status epilepticus patients had delayed initiation of first nonbenzodiazepine- antiseizure medication (149 min [55-491.5 min] vs 62 min [33.3- 120.8 min]; p = 0.030) and of continuous infusion (495 min [177.5-1,255 min] vs 150 min [90-318.5 min]; p = 0.003); prolonged seizure duration (120 hr [58-368 hr] vs 3 hr [1.4-5.9 hr]; p < 0.001) and length of ICU stay (17 d [9.5-40 d] vs [1.8- 8.8 d]; p < 0.001); more medical complications (18/31 [58.1%] vs 55/250 [22.2%] patients; p < 0.001); lower return to baseline function (7/31 [22.6%] vs 182/250 [73.4%] patients; p < 0.001); and higher mortality (4/31 [12.9%] vs 5/250 [2%]; p = 0.010). Within the super-refractory status epilepticus group, status epilepticus resolution was attained with a single continuous infusion in 15 of 31 patients (48.4%), two in 10 of 31 (32.3%), and three or more in six of 31 (19.4%). Most super-refractory status epilepticus patients (30/31, 96.8%) received midazolam as first choice. About 17 of 31 patients (54.8%) received additional treatments. CONCLUSIONS: Super-refractory status epilepticus patients had delayed initiation of nonbenzodiazepine antiseizure medication treatment, higher number of medical complications and mortality, and lower return to neurologic baseline than nonsuper-refractory status epilepticus patients, although these associations were not adjusted for potential confounders. Treatment approaches following the first continuous infusion were heterogeneous, reflecting limited information to guide clinical decision-making in super-refractory status epilepticus.

Original languageEnglish (US)
Pages (from-to)E613-E625
JournalPediatric Critical Care Medicine
Issue number12
StatePublished - Dec 1 2021


  • Critical care unit
  • Epilepsy
  • Refractory status epilepticus
  • Superrefractory status epilepticus
  • Time to treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine


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