{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:37:27Z","timestamp":1793356647306,"version":"4.5.0"},"reference-count":93,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T00:00:00Z","timestamp":1615334400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Epilepsy Curr"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Super-refractory status epilepticus (SRSE) presents management challenges due to the absence of randomized controlled trials and a plethora of potential medical therapies. The literature on treatment options for SRSE reports variable success and quality of evidence. This review is a sequel to the 2020 American Epilepsy Society (AES) comprehensive review of the treatment of convulsive refractory status epilepticus (RSE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We sought to determine the effectiveness of treatment options for SRSE. We performed a structured literature search (MEDLINE, Embase, CENTRAL, CINAHL) for studies on reported treatments of SRSE. We excluded antiseizure medications (ASMs) covered in the 2016 AES guideline on the treatment of established SE and the convulsive RSE comprehensive review of the 2020 AES. Literature was reviewed on the effectiveness of vagus nerve stimulation, ketogenic diet (KD), lidocaine, inhalation anesthetics, brain surgery, therapeutic hypothermia, perampanel, pregabalin (PGB), and topiramate in the treatment of SRSE. Two authors reviewed each therapeutic intervention. We graded the level of the evidence according to the 2017 classification scheme of the American Academy of Neurology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>For SRSE (level U; 39 class IV studies total), insufficient evidence exists to support that perampanel, PGB, lidocaine, or acute vagus nerve stimulation (VNS) is effective. For children and adults with SRSE, insufficient evidence exists to support that the KD is effective (level U; 5 class IV studies). For adults with SRSE, insufficient evidence exists that brain surgery is effective (level U, 7 class IV studies). For adults with SRSE insufficient, evidence exists that therapeutic hypothermia is effective (level C, 1 class II and 4 class IV studies). For neonates with hypoxic-ischemic encephalopathy, insufficient evidence exists that therapeutic hypothermia reduces seizure burden (level U; 1 class IV study). For adults with SRSE, insufficient evidence exists that inhalation anesthetics are effective (level U, 1 class IV study) and that there is a potential risk of neurotoxicity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>For patients with SRSE insufficient, evidence exists that any of the ASMs reviewed, inhalational anesthetics, ketogenic diet, acute VNS, brain surgery, and therapeutic hypothermia are effective treatments. Data supporting the use of these treatments for SRSE are scarce and limited mainly to small case series and case reports and are confounded by differences in patients\u2019 population, and comedications, among other factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1535759721999670","type":"journal-article","created":{"date-parts":[[2021,3,10]],"date-time":"2021-03-10T05:43:32Z","timestamp":1615355012000},"page":"405-415","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":43,"title":["Treatment of Super-Refractory Status Epilepticus: A Review"],"prefix":"10.1177","volume":"21","author":[{"given":"Juan G.","family":"Ochoa","sequence":"first","affiliation":[{"name":"University of South Alabama, Mobile, AL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Dougherty","sequence":"additional","affiliation":[{"name":"Neurotech LLC, Waukesha, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Papanastassiou","sequence":"additional","affiliation":[{"name":"UT Health San Antonio, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Gidal","sequence":"additional","affiliation":[{"name":"University of Wisconsin, Madison, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Alabama, Birmingham, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4823-0537","authenticated-orcid":false,"given":"David G.","family":"Vossler","sequence":"additional","affiliation":[{"name":"University of Washington, Seattle, WA, USA"},{"name":"Treatments Committee, American Epilepsy Society, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,3,10]]},"reference":[{"key":"bibr1-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13121"},{"key":"bibr2-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awr215"},{"key":"bibr3-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-012-9695-z"},{"key":"bibr4-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-015-0589-2"},{"issue":"7","key":"bibr5-1535759721999670","doi-asserted-by":"crossref","first-page":"12","DOI":"10.4103\/neuroindia.NI_958_16","volume":"65","author":"Dubey D","year":"2017","journal-title":"Neurology India"},{"key":"bibr6-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2018.11.011"},{"issue":"8","key":"bibr7-1535759721999670","doi-asserted-by":"crossref","first-page":"2314","DOI":"10.1093\/brain\/aws091","volume":"135","author":"Ferlisi M","year":"2012","journal-title":"Brain"},{"key":"bibr8-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2016.1572"},{"key":"bibr9-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03510370032016"},{"key":"bibr10-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1905795"},{"key":"bibr11-1535759721999670","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597-16.1.48"},{"key":"bibr12-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-017-0859-1"},{"issue":"8","key":"bibr13-1535759721999670","first-page":"SR01","volume":"11","author":"Aroor S","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"bibr14-1535759721999670","author":"Vossler DG","journal-title":"Epilepsy Curr"},{"key":"bibr15-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13837"},{"key":"bibr16-1535759721999670","unstructured":"Higgins J, Green S. Cochrane handbook for systematic reviews of interventions, 2020. Version 6.1. https:\/\/handbook-5-1.cochrane.org\/"},{"key":"bibr17-1535759721999670","author":"Gronseth GS","journal-title":"Am Acad Neurol"},{"key":"bibr18-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.262"},{"key":"bibr19-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-5949.2010.00168.x"},{"key":"bibr20-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12144"},{"key":"bibr21-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1789.2010.01155.x"},{"key":"bibr22-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.nbd.2006.05.008"},{"key":"bibr23-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1608193"},{"key":"bibr24-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2015.31"},{"key":"bibr25-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-008-9092-9"},{"key":"bibr26-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.12331"},{"key":"bibr27-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2011-300716"},{"key":"bibr28-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03241.x"},{"key":"bibr29-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182a393d1"},{"key":"bibr30-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1990.tb05852.x"},{"key":"bibr31-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2001.10900.x"},{"key":"bibr32-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2019.05.011"},{"key":"bibr33-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2015.02.014"},{"issue":"99","key":"bibr34-1535759721999670","first-page":"1037","author":"Geyelin HR","year":"1921","journal-title":"Medical Recodrs"},{"key":"bibr35-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2010.09.002"},{"key":"bibr36-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.13038"},{"key":"bibr37-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1038\/nm.3804"},{"key":"bibr38-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2006.11.065"},{"key":"bibr39-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1002\/epi4.12225"},{"key":"bibr40-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2018.04.012"},{"key":"bibr41-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03289.x"},{"key":"bibr42-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2013.07.020"},{"key":"bibr43-1535759721999670","doi-asserted-by":"publisher","DOI":"10.5698\/1535-7597.17.6.346"},{"key":"bibr44-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2016.08.004"},{"key":"bibr45-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2014.12.008"},{"key":"bibr46-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2013.03.007"},{"key":"bibr47-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000000151"},{"key":"bibr48-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003690"},{"key":"bibr49-1535759721999670","author":"Francis BA","journal-title":"Neurocrit Care"},{"key":"bibr50-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02388.x"},{"key":"bibr51-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2016.07.006"},{"key":"bibr52-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02703.x"},{"key":"bibr53-1535759721999670","author":"Park EG","journal-title":"Brain Dev"},{"key":"bibr54-1535759721999670","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2019.00423"},{"key":"bibr55-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1177\/0883073813516192"},{"key":"bibr56-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181dc1dd6"},{"key":"bibr57-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2015.278"},{"key":"bibr58-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2007.02.003"},{"key":"bibr59-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-011-9546-3"},{"key":"bibr60-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1389898"},{"key":"bibr61-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1992.tb02200.x"},{"key":"bibr62-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-198911000-00005"},{"key":"bibr63-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2014.121"},{"key":"bibr64-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.61.8.1254"},{"key":"bibr65-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2013-303786"},{"key":"bibr66-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-016-0340-0"},{"key":"bibr67-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181f6da34"},{"key":"bibr68-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2007.01353.x"},{"key":"bibr69-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1992.tb01707.x"},{"key":"bibr70-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.1992.tb08558.x"},{"key":"bibr71-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1993.tb00441.x"},{"key":"bibr72-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/S0920-1211(01)00252-2"},{"key":"bibr73-1535759721999670","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.70.2.0231"},{"key":"bibr74-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2018.07.004"},{"key":"bibr75-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/ane.13061"},{"key":"bibr76-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2015.04.005"},{"key":"bibr77-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14494"},{"key":"bibr78-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.14492"},{"key":"bibr79-1535759721999670","first-page":"3218231","volume":"2019","author":"Newey CR","year":"2019","journal-title":"Case Rep Crit Care"},{"key":"bibr80-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebcr.2015.06.007"},{"key":"bibr81-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02646.x"},{"key":"bibr82-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-011-9626-4"},{"key":"bibr83-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2012.11.004"},{"key":"bibr84-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.yebeh.2007.06.012"},{"key":"bibr85-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebcr.2012.10.003"},{"key":"bibr86-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/epi.16382"},{"key":"bibr87-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2006.00564.x"},{"key":"bibr88-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1046\/j.1528-1157.2003.11803.x"},{"key":"bibr89-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1327771"},{"key":"bibr90-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2017-3971"},{"key":"bibr91-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-016-0672-2"},{"key":"bibr92-1535759721999670","doi-asserted-by":"publisher","DOI":"10.2165\/11633090-000000000-00000"},{"key":"bibr93-1535759721999670","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2016.03.003"}],"container-title":["Epilepsy Currents"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1535759721999670","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1535759721999670","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1535759721999670","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T20:30:55Z","timestamp":1777408255000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1535759721999670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,10]]},"references-count":93,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.1177\/1535759721999670"],"URL":"https:\/\/doi.org\/10.1177\/1535759721999670","relation":{},"ISSN":["1535-7597","1535-7511"],"issn-type":[{"value":"1535-7597","type":"print"},{"value":"1535-7511","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,10]]}}}