Treatment of Refractory Convulsive Status Epilepticus in Children: Other Therapies

Refractory convulsive status epilepticus occurs when seizures are not controlled with initial benzodiazepine therapy or a subsequent anticonvulsant drug. Typically drug-induced anesthesia is then pursued with midazolam or a barbiturate. This results in prolonged, intensive care, which requires meticulous attention to medical management to minimize complications. When seizures persist other options must be considered. These include (1) other medications, (2) surgery, (3) the ketogenic diet, (4) hypothermia, (5) inhalational anesthetic agents, and (6) immune modulating therapy. This review addresses the literature related to the use of the latter (4) treatment options. I will discuss the role of each treatment and review the evidence for it's use, along with possible side-effects.