{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T05:16:30Z","timestamp":1790054190244,"version":"4.0.1"},"reference-count":0,"publisher":"Ordem dos Medicos","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Med Port"],"abstract":"<jats:p>Introduction: Super-refractory status epilepticus is defined as status epilepticus that persists or recurs 24 hours after anaesthetic\u00a0therapy onset or after its withdrawal. It is mostly found in intensive care units and carries high mortality but good long-term prognosis\u00a0for those who survive. In contrast with the initial phases of status epilepticus, treatment lacks strong scientific evidence and is mostly\u00a0derived from case reports or small case series.Objective: To propose a protocol for the treatment of super-refractory status epilepticus in level III intensive care units, focusing on the\u00a0treatment strategies to control clinical and\/or electroencephalographic epileptic activity.Material and Methods: Narrative review of the literature by PubMed search. Available evidence was discussed in consensus meetings\u00a0by intensive care and neurology experts\u2019 from a level III intensive care unit and one of the Portuguese reference centres for the treatment\u00a0of refractory epilepsy, respectively.Results: Anaesthetics with the highest level of evidence are propofol, midazolam, thiopental and ketamine. These represent the basis\u00a0of the treatment of super-refractory status epilepticus and should be used in combination with antiepileptic drugs. The level of evidence\u00a0for the latter is lower, however, levetiracetam, topiramate, pregabalin, lacosamide, valproic acid, phenytoin and perampanel may be\u00a0recommended. Alternative therapeutic strategies with very low level of evidence are recommended in cases of total absence of clinical\u00a0response, such as magnesium sulphate, pyridoxine, ketogenic diet, therapeutic hypothermia and immunosupression.Conclusion: We propose a treatment protocol based on a sequential combination of anaesthetics, anti-epileptic drugs and alternative\u00a0therapies. Strategies to evaluate treatment response and to wean drugs based on clinical results are also proposed.<\/jats:p>","DOI":"10.20344\/amp.9679","type":"journal-article","created":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T22:44:51Z","timestamp":1541025891000},"page":"598-605","source":"Crossref","is-referenced-by-count":17,"title":["Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus"],"prefix":"10.20344","volume":"31","author":[{"given":"Daniel","family":"Gomes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Pimentel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Bentes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Aguiar de Sousa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Patr\u00edcia","family":"Antunes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f3nio","family":"Alvarez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z\u00e9lia Costa e","family":"Silva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"8464","published-online":{"date-parts":[[2018,10,31]]},"container-title":["Acta M\u00e9dica Portuguesa"],"original-title":[],"link":[{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/download\/9679\/5526","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/download\/9679\/5526","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,25]],"date-time":"2022-10-25T08:32:53Z","timestamp":1666686773000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.actamedicaportuguesa.com\/revista\/index.php\/amp\/article\/view\/9679"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,31]]},"references-count":0,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2018,10,31]]}},"URL":"https:\/\/doi.org\/10.20344\/amp.9679","relation":{},"ISSN":["1646-0758","0870-399X"],"issn-type":[{"value":"1646-0758","type":"electronic"},{"value":"0870-399X","type":"print"}],"subject":[],"published":{"date-parts":[[2018,10,31]]}}}