AAN 2024 | The management of refractory and super-refractory status epilepticus

Clio Rubinos, MD, University of North Carolina at Chapel Hill, Chapel Hill, NC, discusses the challenges associated with managing refractory and super refractory status epilepticus. There is a body of data supporting the use of benzodiazepines in order to prevent disease progression; however, a recent post-hoc analysis identified that 70% of patients receiving these agents are under-dosed. Following treatment failure on benzodiazepines, three well-studied drugs are available to treat patients – levetiracetam, valproic acid, and fosphenytoin – but Dr Rubinos highlights that the efficacy of these agents is ~50%. Late stages of the disease require treatment with high-dose anesthetics, which are associated with long-term complications, and there is a lack of evidence on the best anesthetics to deploy in this setting. Therefore, the development of novel strategies is necessary, and a drug targeting the GABAA receptor outside of the synaptic cleft is showing promise in an ongoing trial. Dr Rubinos also expresses her excitement at the potential for vitamin B6 (pyridoxine) supplementation, highlighting that, in her clinic, 80% of patients with status epilepticus were deficient in this compound. This interview took place at the American Academy of Neurology (AAN) Annual Meeting 2024 in Denver, CO.

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