Novel Therapies in the Critical Care Management of Refractory and Super- Refractory Status Epilepticus

Abstract

Background: Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are neurological emergencies that pose significant challenges to the managing neurointensivist. Changes in neuro-receptors and transport proteins that occur in uncontrolled seizures typically lead to failure of first- and second-line anti-epileptic drug therapy. Thus, novel techniques are required. The use of MgSO4, electroconvulsive therapy (ECT), and transcranial magnetic stimulation (TMS) are such novel therapies that have limited case reports to date. Since controlled studies are not feasible with the treatment options available, current management of RSE and SRSE is based on small independent case reports. Objective: To perform three separate systematic literature reviews in order to determine the efficacy of MgSO4, ECT, and TMs on seizure control in RSE/SRSE. The resulting data will guide future studies into these three areas of RSE/SRSE management. Methods: Three separate systematic reviews will be performed of the following databases: Medline, SCOPUS, Embase, Global Health, BIOSIS, and Cochrane Libraries/Trials Databases. We will search the WHO International Trials Database and Clinicaltrials.gov for any ongoing research in the areas of interest. Finally, we will search the published meeting proceedings of the relevant societies. The data that is extracted from the articles will meet predefine inclusion/exclusion criteria as determined by two independent reviewers. It will be tabulated and summarized to determine the efficacy of each treatment in the literature to date. Conclusion: The results of these reviews will provide a definitive review on each of these therapies, aiding further development of either local or multicenter prospective studies.