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Our patient was initially treated with first\u2010, second\u2010 and third\u2010line agents including a total of seven failed drug\u2010induced coma courses until the 30<jats:sup>th<\/jats:sup> day of hospitalization. When withdrawal of care was contemplated, management was then assumed by dedicated epileptologists and treatment course was changed. An unorthodox decision was made to avoid IV anaesthetics unless there were generalized bisynchronous tonic\u2010clonic or generalized non\u2010convulsive (electrographic) seizures. This approach allowed real\u2010time assessment of treatment response to aggressive non\u2010sedating AED therapy while the multifocal convulsive and non\u2010convulsive seizures were ongoing. It also eliminated potentially fatal IV anaesthetic\u2010induced complications and prevented anaesthetic withdrawal seizures. This was effective in achieving full recovery in our patient. The patient's awakening also changed the perspective of family members and care providers, avoiding premature withdrawal of care, which is often the cause of death in similar patients.<\/jats:p>","DOI":"10.1684\/epd.2019.1104","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T16:27:32Z","timestamp":1706027252000},"page":"483-491","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Avoiding anaesthetics after multiple failed drug\u2010induced comas: an unorthodox approach to management of new\u2010onset refractory status epilepticus (NORSE)"],"prefix":"10.1002","volume":"21","author":[{"given":"James E.","family":"Eaton","sequence":"first","affiliation":[{"name":"Department of Neurology Vanderbilt University Medical Center Nashville TN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew 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