Refrakterni i superrefrakterni epileptički status

master's thesis

• Title (english): Refractory and super-refractory status epilepticus
• Author: Iva Benić
• Mentor: Zdravka Poljaković-Skurić (mentor)
• Committee member: Željka Petelin Gadže (predsjednik povjerenstva)
• Committee member: Mario Habek (član povjerenstva)
• Committee member: Zdravka Poljaković-Skurić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Neurology); Zagreb
• Defense date and country: 2022-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Neurology

Abstract

Epileptički status je hitno stanje u neurologiji visokog mortaliteta i morbiditeta. Refrakteran
status je onaj koji ne odgovora na prve dvije linije liječenja dok je superrefrakteran onaj čije je
trajanje dulje od 24 sata usprkos primjeni treće linije liječenja to jest anestetika. Njihova
prognoza još je lošija. Epileptički status najčešće je posljedica strukturalnih promjena
moždanog tkiva, uzrokovan akutnom simptomatskom etiologijom, a na prvom su mjestu
cerebrovaskularne bolesti.. Autoimuni, infektivni te paraneoplastički uzroci posebno se
povezuju upravo sa refrakternim i superrefrakternim oblicima. Patofiziološke promjene do kojih
dolazi u produljenom napadaju podržavaju epileptičku aktivnost. Što napadaj dulje traje manja
je vjerojatnost da će se on zaustaviti, a sve slabiji postaje i odgovor na terapiju. Osim toga,
raste rizik od ozljede neurona i zaostajanja trajnih neuroloških posljedica, kao i rizik
multiorganske disfunkcije. Klinički se epileptički status može podijeliti prema stupnju
poremećaja svijesti i prema postojanju motornih simptoma. U refrakternim odnosno
superrefrakternim slučajevima često se radi o osobama bez svijesti sa nekonvulzivnim
napadajima. Pacijente sa nekonvulzivnim statusom teže je prepoznati, a glavnu ulogu u
detekciji epileptičke aktivnosti tada ima elektroencefalogram. Kontinuirani EEG jedna je od
ključnih sastavnica u zbrinjavanju pacijenata sa refrakternim i superrefrakternim statusom.
Unatoč brojnim lijekovima i dodatnim metodama liječenja, zbrinjavanje tih pacijenata obično je
vrlo zahtjevno, a komplikacije su očekivana pojava. Kao posebna skupina izdvaja se NORSE,
to jest novonastali refrakterni epileptički status, koji je povezan sa izrazito lošim ishodima.
Cilj je ovog rada sažeto prikazati definicije, etiologiju, semiologiju i patofiziologiju te
dijagnostički i terapijski pristup kod refrakternog i superrefrakternog epileptičkog statusa te
ilustrirati ovaj klinički problem prikazom bolesnika s dijagnozom SRSE iz kliničke prakse.

Abstract (english)

Status epilepticus is a neurological emergency with significant mortality and morbidity. Refractory status epilepticus occurs when seizures persist despite the administration of the first two line medications, while super-refractory status is a seizure that persists despite the treatment with IV anesthetic or a status which does not stop after 24 hours in spite of the third line treatment. Refractory and super-refractory status epilepticus are associated with even worse prognosis. Status epilepticus is most often due to an acute symptomatic etiology. Autoimmune, infectious and paraneoplastic causes are particularly related to refractory and super-refractory cases. Pathophysiological changes in prolonged seizures support the continuation of epileptic activity. Therefore, the longer the seizure lasts it becomes less likely to end, while the response to the treatment becomes weaker and weaker. In addition to that, prolonged epileptic activity results in neuronal injury leaving permanent damage, as well as the increased risk of multiorgan failure. Epileptic status is categorized according to the level of impaired consciousness and the presence of motor symptoms. In refractory and super-refractory patients the loss of consciousness without prominent motor symptoms (non-convulsive SE) can be detected more often. EEG plays the main role in detecting seizures in most cases of non-convulsive SE that are otherwise hard to recognize. Continuous EEG monitoring is one of the key components in care for patients with refractory and super-refractory epileptic status. Despite numerous medications and other therapeutic options, the care of these patients is usually very challenging, with complications being the norm. NORSE stands out as a distinguished subgroup representing new-onset refractory epileptic status and is linked to an extremely poor prognosis. The aim of this paper is to summarize the definitions, etiology, semiology and pathophysiology, as well as the diagnostic and therapeutic approach in refractory and super-refractory status epilepticus and to illustrate this clinical problem with a case report from every-day practice.

• Keywords: RSE (refrakterni epileptički status); SRSE (superrefrakterni epileptički status); NCSE (nekonvulzivni epileptički status); NORSE (novonastali refrakterni epileptički status); FIRES (epilepsijski sindrom povezan sa povišenom temperaturom)
• Keywords (english): RSE (refractory status epilepticus); SRSE (super-refractory status epilepticus); NCSE (non-convulsive status epilepticus); NORSE (new-onset refractory status epilepticus); FIRES (febrile infection-related epilepsy syndrome)
• Language: croatian
• URN:NBN: urn:nbn:hr:105:819340
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-01-03 11:28:50