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.