Korean J Crit Care Med.  2017 May;32(2):89-105. 10.4266/kjccm.2017.00252.

Status Epilepticus and Beyond: A Clinical Review of Status Epilepticus and an Update on Current Management Strategies in Super-refractory Status Epilepticus

Affiliations
  • 1Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA. gsung@usc.edu

Abstract

Status epilepticus and refractory status epilepticus represent some of the most complex conditions encountered in the neurological intensive care unit. Challenges in management are common as treatment options become limited and prolonged hospital courses are accompanied by complications and worsening patient outcomes. Antiepileptic drug treatments have become increasingly complex. Rational polytherapy should consider the pharmacodynamics and kinetics of medications. When seizures cannot be controlled with medical therapy, alternative treatments, including early surgical evaluation can be considered; however, evidence is limited. This review provides a brief overview of status epilepticus, and a recent update on the management of refractory status epilepticus based on evidence from the literature, evidence-based guidelines, and experiences at our institution.

Keyword

anticonvulsants; intensive care; pharmacokinetics; seizures; status epilepticus

MeSH Terms

Anticonvulsants
Complementary Therapies
Critical Care
Humans
Intensive Care Units
Kinetics
Pharmacokinetics
Seizures
Status Epilepticus*
Anticonvulsants

Reference

References

1. Dham BS, Hunter K, Rincon F. The epidemiology of status epilepticus in the United States. Neurocrit Care. 2014; 20:476–83.
Article
2. Penberthy LT, Towne A, Garnett LK, Perlin JB, DeLorenzo RJ. Estimating the economic burden of status epilepticus to the health care system. Seizure. 2005; 14:46–51.
Article
3. Strzelczyk A, Knake S, Oertel WH, Rosenow F, Hamer HM. Inpatient treatment costs of status epilepticus in adults in Germany. Seizure. 2013; 22:882–5.
Article
4. Gastaut H. Clinical and electroencephalographical classification of epileptic seizures. Epilepsia. 1970; 11:102–13.
Article
5. Brodie MJ. Status epilepticus in adults. Lancet. 1990; 336:551–2.
Article
6. Meldrum BS, Horton RW. Physiology of status epilepticus in primates. Arch Neurol. 1973; 28:1–9.
Article
7. Trinka E, Cock H, Hesdorffer D, Rossetti AO, Scheffer IE, Shinnar S, et al. A definition and classification of status epilepticus: report of the ILAE Task Force on Classification of Status Epilepticus. Epilepsia. 2015; 56:1515–23.
8. Lowenstein DH, Alldredge BK. Status epilepticus. N Engl J Med. 1998; 338:970–6.
Article
9. Brophy GM, Bell R, Claassen J, Alldredge B, Bleck TP, Glauser T, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012; 17:3–23.
Article
10. Mayer SA, Claassen J, Lokin J, Mendelsohn F, Dennis LJ, Fitzsimmons BF. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol. 2002; 59:205–10.
11. Holtkamp M, Othman J, Buchheim K, Meierkord H. Predictors and prognosis of refractory status epilepticus treated in a neurological intensive care unit. J Neurol Neurosurg Psychiatry. 2005; 76:534–9.
Article
12. Ferlisi M, Shorvon S. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain. 2012; 135(Pt 8):2314–28.
Article
13. Beg JM, Anderson TD, Francis K, Meckley LM, Fitzhenry D, Foster T, et al. Burden of illness for super-refractory status epilepticus patients. J Med Econ. 2017; 20:45–53.
Article
14. Gaspard N, Foreman BP, Alvarez V, Cabrera Kang C, Probasco JC, Jongeling AC, et al. New-onset refractory status epilepticus: etiology, clinical features, and outcome. Neurology. 2015; 85:1604–13.
15. DeLorenzo RJ, Pellock JM, Towne AR, Boggs JG. Epidemiology of status epilepticus. J Clin Neurophysiol. 1995; 12:316–25.
Article
16. DeLorenzo RJ, Towne AR, Pellock JM, Ko D. Status epilepticus in children, adults, and the elderly. Epilepsia. 1992; 33 Suppl 4:S15–25.
Article
17. Shinnar S, Pellock JM, Moshé SL, Maytal J, O’Dell C, Driscoll SM, et al. In whom does status epilepticus occur: age-related differences in children. Epilepsia. 1997; 38:907–14.
Article
18. Glaser CA, Gilliam S, Honarmand S, Tureen JH, Lowenstein DH, Anderson LJ, et al. Refractory status epilepticus in suspect encephalitis. Neurocrit Care. 2008; 9:74–82.
Article
19. Van Lierde I, Van Paesschen W, Dupont P, Maes A, Sciot R. De novo cryptogenic refractory multifocal febrile status epilepticus in the young adult: a review of six cases. Acta Neurol Belg. 2003; 103:88–94.
20. Wilder-Smith EP, Lim EC, Teoh HL, Sharma VK, Tan JJ, Chan BP, et al. The NORSE (new-onset refractory status epilepticus) syndrome: defining a disease entity. Ann Acad Med Singapore. 2005; 34:417–20.
21. Hoerth MT, Sirven JI, Drazkowski JF, Noe KH. Malignant status epilepticus syndrome: refractory idiopathic status epilepticus. Epilepsia. 2007; 48:P012.
22. Costello DJ, Kilbride RD, Cole AJ. Cryptogenic New Onset Refractory Status Epilepticus (NORSE) in adults: infectious or not? J Neurol Sci. 2009; 277:26–31.
23. Holmes GL, Ben-Ari Y. Seizing hold of seizures. Nat Med. 2003; 9:994–6.
Article
24. Chen JW, Naylor DE, Wasterlain CG. Advances in the pathophysiology of status epilepticus. Acta Neurol Scand. 2007; 115(4 Suppl):7–15.
Article
25. Mazarati AM, Baldwin RA, Sankar R, Wasterlain CG. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res. 1998; 814:179–85.
Article
26. Theodore WH, Porter RJ, Albert P, Kelley K, Bromfield E, Devinsky O, et al. The secondarily generalized tonic-clonic seizure: a videotape analysis. Neurology. 1994; 44:1403–7.
27. Mazarati AM, Liu H, Soomets U, Sankar R, Shin D, Katsumori H, et al. Galanin modulation of seizures and seizure modulation of hippocampal galanin in animal models of status epilepticus. J Neurosci. 1998; 18:10070–7.
Article
28. Mazarati A, Liu H, Wasterlain C. Opioid peptide pharmacology and immunocytochemistry in an animal model of self-sustaining status epilepticus. Neuroscience. 1999; 89:167–73.
Article
29. Liu H, Mazarati AM, Katsumori H, Sankar R, Wasterlain CG. Substance P is expressed in hippocampal principal neurons during status epilepticus and plays a critical role in the maintenance of status epilepticus. Proc Natl Acad Sci U S A. 1999; 96:5286–91.
Article
30. Vezzani A, Sperk G, Colmers WF. Neuropeptide Y: emerging evidence for a functional role in seizure modulation. Trends Neurosci. 1999; 22:25–30.
Article
31. Meldrum BS, Vigouroux RA, Brierley JB. Systemic factors and epileptic brain damage: prolonged seizures in paralyzed, artificially ventilated baboons. Arch Neurol. 1973; 29:82–7.
32. Meldrum BS, Brierley JB. Prolonged epileptic seizures in primates: ischemic cell change and its relation to ictal physiological events. Arch Neurol. 1973; 28:10–7.
33. Nevander G, Ingvar M, Auer R, Siesjö BK. Status epilepticus in well-oxygenated rats causes neuronal necrosis. Ann Neurol. 1985; 18:281–90.
Article
34. Wasterlain CG, Fujikawa DG, Penix L, Sankar R. Pathophysiological mechanisms of brain damage from status epilepticus. Epilepsia. 1993; 34 Suppl 1:S37–53.
Article
35. Pollard H, Charriaut-Marlangue C, Cantagrel S, Represa A, Robain O, Moreau J, et al. Kainate-induced apoptotic cell death in hippocampal neurons. Neuroscience. 1994; 63:7–18.
Article
36. Niquet J, Baldwin RA, Allen SG, Fujikawa DG, Wasterlain CG. Hypoxic neuronal necrosis: protein synthesis-independent activation of a cell death program. Proc Natl Acad Sci U S A. 2003; 100:2825–30.
Article
37. DeGiorgio CM, Correale JD, Gott PS, Ginsburg DL, Bracht KA, Smith T, et al. Serum neuron-specific enolase in human status epilepticus. Neurology. 1995; 45:1134–7.
Article
38. DeGiorgio CM, Heck CN, Rabinowicz AL, Gott PS, Smith T, Correale J. Serum neuron-specific enolase in the major subtypes of status epilepticus. Neurology. 1999; 52:746–9.
Article
39. Corsellis JA, Bruton CJ. Neuropathology of status epilepticus in humans. Adv Neurol. 1983; 34:129–39.
40. Engel J Jr, Ludwig BI, Fetell M. Prolonged partial complex status epilepticus: EEG and behavioral observations. Neurology. 1978; 28(9 Pt 1):863–9.
Article
41. DeGiorgio CM, Gott PS, Rabinowicz AL, Heck CN, Smith TD, Correale JD. Neuron-specific enolase, a marker of acute neuronal injury, is increased in complex partial status epilepticus. Epilepsia. 1996; 37:606–9.
Article
42. Rabinowicz AL, Correale JD, Bracht KA, Smith TD, DeGiorgio CM. Neuron-specific enolase is increased after nonconvulsive status epilepticus. Epilepsia. 1995; 36:475–9.
Article
43. Shirasaka Y. Lack of neuronal damage in atypical absence status epilepticus. Epilepsia. 2002; 43:1498–501.
Article
44. Cockerell OC, Walker MC, Sander JW, Shorvon SD. Complex partial status epilepticus: a recurrent problem. J Neurol Neurosurg Psychiatry. 1994; 57:835–7.
Article
45. Cherian A, Thomas SV. Status epilepticus. Ann Indian Acad Neurol. 2009; 12:140–53.
Article
46. Lothman E. The biochemical basis and pathophysiology of status epilepticus. Neurology. 1990; 40(5 Suppl 2):13–23.
47. Claassen J, Mayer SA, Kowalski RG, Emerson RG, Hirsch LJ. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology. 2004; 62:1743–8.
Article
48. Schmitt SE. Utility of clinical features for the diagnosis of seizures in the intensive care unit. J Clin Neurophysiol. 2017; 34:158–61.
Article
49. Bleck TP. Status epilepticus and the use of continuous EEG monitoring in the intensive care unit. Continuum (Minneap Minn). 2012; 18:560–78.
Article
50. Wittman JJ Jr, Hirsch LJ. Continuous electroencephalogram monitoring in the critically ill. Neurocrit Care. 2005; 2:330–41.
Article
51. Friedman D, Claassen J, Hirsch LJ. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009; 109:506–23.
Article
52. Laccheo I, Sonmezturk H, Bhatt AB, Tomycz L, Shi Y, Ringel M, et al. Non-convulsive status epilepticus and non-convulsive seizures in neurological ICU patients. Neurocrit Care. 2015; 22:202–11.
Article
53. Towne AR, Waterhouse EJ, Boggs JG, Garnett LK, Brown AJ, Smith JR Jr, et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology. 2000; 54:340–5.
Article
54. Westover MB, Shafi MM, Bianchi MT, Moura LM, O’Rourke D, Rosenthal ES, et al. The probability of seizures during EEG monitoring in critically ill adults. Clin Neurophysiol. 2015; 126:463–71.
Article
55. Swisher CB, Shah D, Sinha SR, Husain AM. Baseline EEG pattern on continuous ICU EEG monitoring and incidence of seizures. J Clin Neurophysiol. 2015; 32:147–51.
Article
56. Shafi MM, Westover MB, Cole AJ, Kilbride RD, Hoch DB, Cash SS. Absence of early epileptiform abnormalities predicts lack of seizures on continuous EEG. Neurology. 2012; 79:1796–801.
Article
57. Glauser T, Shinnar S, Gloss D, Alldredge B, Arya R, Bainbridge J, et al. Evidence-based guideline: treatment of convulsive status epilepticus in children and adults. Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016; 16:48–61.
Article
58. Treiman DM, Meyers PD, Walton NY, Collins JF, Colling C, Rowan AJ, et al. A comparison of four treatments for generalized convulsive status epilepticus: Veterans Affairs Status Epilepticus Cooperative Study Group. N Engl J Med. 1998; 339:792–8.
59. Trinka E, Höfler J, Leitinger M, Brigo F. Pharmacotherapy for status epilepticus. Drugs. 2015; 75:1499–521.
Article
60. Cranford RE, Leppik IE, Patrick B, Anderson CB, Kostick B. Intravenous phenytoin in acute treatment of seizures. Neurology. 1979; 29:1474–9.
Article
61. Patsalos PN. Clinical pharmacokinetics of levetiracetam. Clin Pharmacokinet. 2004; 43:707–24.
Article
62. Misra UK, Kalita J, Maurya PK. Levetiracetam versus lorazepam in status epilepticus: a randomized, open labeled pilot study. J Neurol. 2012; 259:645–8.
Article
63. Yasiry Z, Shorvon SD. The relative effectiveness of five antiepileptic drugs in treatment of benzodiazepine resistant convulsive status epilepticus: a meta-analysis of published studies. Seizure. 2014; 23:167–74.
64. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002; 43:146–53.
Article
65. Singhi S, Murthy A, Singhi P, Jayashree M. Continuous midazolam versus diazepam infusion for refractory convulsive status epilepticus. J Child Neurol. 2002; 17:106–10.
Article
66. Kumar A, Bleck TP. Intravenous midazolam for the treatment of refractory status epilepticus. Crit Care Med. 1992; 20:483–8.
Article
67. Stover JF, Stocker R. Barbiturate coma may promote reversible bone marrow suppression in patients with severe isolated traumatic brain injury. Eur J Clin Pharmacol. 1998; 54:529–34.
Article
68. Melamed R, Bar-Yosef S, Shakhar G, Shakhar K, Ben-Eliyahu S. Suppression of natural killer cell activity and promotion of tumor metastasis by ketamine, thiopental, and halothane, but not by propofol: mediating mechanisms and prophylactic measures. Anesth Analg. 2003; 97:1331–9.
Article
69. Krishnamurthy KB, Drislane FW. Depth of EEG suppression and outcome in barbiturate anesthetic treatment for refractory status epilepticus. Epilepsia. 1999; 40:759–62.
Article
70. Rossetti AO, Logroscino G, Bromfield EB. Refractory status epilepticus: effect of treatment aggressiveness on prognosis. Arch Neurol. 2005; 62:1698–702.
71. Bourgeois BF. Pharmacokinetic properties of current antiepileptic drugs: what improvements are needed? Neurology. 2000; 55(11 Suppl 3):S11–6.
72. Ramael S, De Smedt F, Toublanc N, Otoul C, Boulanger P, Riethuisen JM, et al. Single-dose bioavailability of levetiracetam intravenous infusion relative to oral tablets and multiple-dose pharmacokinetics and tolerability of levetiracetam intravenous infusion compared with placebo in healthy subjects. Clin Ther. 2006; 28:734–44.
Article
73. Smith BS, Yogaratnam D, Levasseur-Franklin KE, Forni A, Fong J. Introduction to drug pharmacokinetics in the critically ill patient. Chest. 2012; 141:1327–36.
74. Swadron SP, Rudis MI, Azimian K, Beringer P, Fort D, Orlinsky M. A comparison of phenytoin-loading techniques in the emergency department. Acad Emerg Med. 2004; 11:244–52.
Article
75. May T, Rambeck B. Serum concentrations of valproic acid: influence of dose and comedication. Ther Drug Monit. 1985; 7:387–90.
76. Perucca E. Clinically relevant drug interactions with antiepileptic drugs. Br J Clin Pharmacol. 2006; 61:246–55.
Article
77. Wasterlain CG, Baldwin R, Naylor DE, Thompson KW, Suchomelova L, Niquet J. Rational polytherapy in the treatment of acute seizures and status epilepticus. Epilepsia. 2011; 52 Suppl 8:70–1.
Article
78. Abend NS, Dlugos DJ. Treatment of refractory status epilepticus: literature review and a proposed protocol. Pediatr Neurol. 2008; 38:377–90.
Article
79. Lee JW, Dworetzky B. Rational polytherapy with antiepileptic drugs. Pharmaceuticals (Basel). 2010; 3:2362–79.
Article
80. Gillard M, Fuks B, Leclercq K, Matagne A. Binding characteristics of brivaracetam, a selective, high affinity SV2A ligand in rat, mouse and human brain: relationship to anti-convulsant properties. Eur J Pharmacol. 2011; 664:36–44.
Article
81. Nicolas JM, Hannestad J, Holden D, Kervyn S, Nabulsi N, Tytgat D, et al. Brivaracetam, a selective high-affinity synaptic vesicle protein 2A (SV2A) ligand with preclinical evidence of high brain permeability and fast onset of action. Epilepsia. 2016; 57:201–9.
82. Wasterlain C, Suchomelova L, Matagne A, Klitgaard H, Mazarati A, Shinmei S, et al. Brivaracetam is a potent anticonvulsant in experimental status epilepticus. Epilepsia. 2005; 46(suppl 8):219–20.
83. Rogawski MA, Loya CM, Reddy K, Zolkowska D, Lossin C. Neuroactive steroids for the treatment of status epilepticus. Epilepsia. 2013; 54 Suppl 6:93–8.
Article
84. Vaitkevicius H, Ng M, Moura L, Rosenthal E, Westover MB, Rosand J, et al. Successful allopregnanolone treatment of new onset refractory status epilepticus (NORSE) syndrome: first in man experience. Epilepsia. 2013; 54(suppl 6):106–24.
85. Broomall E, Natale JE, Grimason M, Goldstein J, Smith CM, Chang C, et al. Pediatric super-refractory status epilepticus treated with allopregnanolone. Ann Neurol. 2014; 76:911–5.
Article
86. Sage Therapeutics. A study with SAGE-547 for super-refractory status epilepticus [Internet]. Bethesda (MD): U.S. National Library of Medicine;2000. [cited 2016 Nov 12]. Available from: https://clinicaltrials.gov/ct2/show/NCT02477618?term=NCT02477618&rank=1.
87. White HS, Alex AB, Pollock A, Hen N, Shekh-Ahmad T, Wilcox KS, et al. A new derivative of valproic acid amide possesses a broad-spectrum antiseizure profile and unique activity against status epilepticus and organophosphate neuronal damage. Epilepsia. 2012; 53:134–46.
Article
88. Bar-Klein G, Swissa E, Kamintsky L, Shekh-Ahmad T, Saar-Ashkenazy R, Hubary Y, et al. sec-Butylpropylacetamide (SPD) and two of its stereoisomers rapidly terminate paraoxon-induced status epilepticus in rats. Epilepsia. 2014; 55:1953–8.
Article
89. Novak GP, Kelley M, Zannikos P, Klein B. Carisbamate (RWJ-333369). Neurotherapeutics. 2007; 4:106–9.
Article
90. Francois J, Ferrandon A, Koning E, Nehlig A. A new drug RWJ 333369 protects limbic areas in the lithium-pilocarpine model (li-pilo) of epilepsy and delays or prevents the occurrence of spontaneous seizures. Epilepsia. 2005; 46(suppl 8):269–70.
91. Synowiec AS, Singh DS, Yenugadhati V, Valeriano JP, Schramke CJ, Kelly KM. Ketamine use in the treatment of refractory status epilepticus. Epilepsy Res. 2013; 105:183–8.
Article
92. Gaspard N, Foreman B, Judd LM, Brenton JN, Nathan BR, McCoy BM, et al. Intravenous ketamine for the treatment of refractory status epilepticus: a retrospective multicenter study. Epilepsia. 2013; 54:1498–503.
Article
93. Kramer AH. Early ketamine to treat refractory status epilepticus. Neurocrit Care. 2012; 16:299–305.
Article
94. Kofke WA, Young RS, Davis P, Woelfel SK, Gray L, Johnson D, et al. Isoflurane for refractory status epilepticus: a clinical series. Anesthesiology. 1989; 71:653–9.
95. Mirsattari SM, Sharpe MD, Young GB. Treatment of refractory status epilepticus with inhalational anesthetic agents isoflurane and desflurane. Arch Neurol. 2004; 61:1254–9.
Article
96. Zhumadilov A, Gilman CP, Viderman D. Management of super-refractory status epilepticus with isoflurane and hypothermia. Front Neurol. 2015; 5:286.
Article
97. Varvel NH, Neher JJ, Bosch A, Wang W, Ransohoff RM, Miller RJ, et al. Infiltrating monocytes promote brain inflammation and exacerbate neuronal damage after status epilepticus. Proc Natl Acad Sci U S A. 2016; 113:E5665–74.
Article
98. Alyu F, Dikmen M. Inflammatory aspects of epileptogenesis: contribution of molecular inflammatory mechanisms. Acta Neuropsychiatr. 2017; 29:1–16.
Article
99. Shorvon S, Ferlisi M. The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol. Brain. 2011; 134(Pt 10):2802–18.
Article
100. Thakur KT, Probasco JC, Hocker SE, Roehl K, Henry B, Kossoff EH, et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology. 2014; 82:665–70.
Article
101. Ye F, Li XJ, Jiang WL, Sun HB, Liu J. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis. J Clin Neurol. 2015; 11:26–31.
Article
102. Liu Z, Gatt A, Mikati M, Holmes GL. Effect of temperature on kainic acid-induced seizures. Brain Res. 1993; 631:51–8.
Article
103. Lundgren J, Smith ML, Blennow G, Siesjo BK. Hyperthermia aggravates and hypothermia ameliorates epileptic brain damage. Exp Brain Res. 1994; 99:43–55.
Article
104. Corry JJ, Dhar R, Murphy T, Diringer MN. Hypothermia for refractory status epilepticus. Neurocrit Care. 2008; 9:189–97.
Article
105. Legriel S, Lemiale V, Schenck M, Chelly J, Laurent V, Daviaud F, et al. Hypothermia for neuroprotection in convulsive status epilepticus. N Engl J Med. 2016; 375:2457–67.
Article
106. Zeiler FA, Matuszczak M, Teitelbaum J, Gillman LM, Kazina CJ. Electroconvulsive therapy for refractory status epilepticus: a systematic review. Seizure. 2016; 35:23–32.
Article
107. Lhatoo SD, Alexopoulos AV. The surgical treatment of status epilepticus. Epilepsia. 2007; 48 Suppl 8:61–5.
Article
108. Mendes A, Sampaio L. Brain magnetic resonance in status epilepticus: a focused review. Seizure. 2016; 38:63–7.
Article
109. MD’Giano CH, Del C García M, Pomata H, Rabinowicz AL. Treatment of refractory partial status epilepticus with multiple subpial transection: case report. Seizure. 2001; 10:382–5.
Article
110. Ma X, Liporace J, O’Connor MJ, Sperling MR. Neurosurgical treatment of medically intractable status epilepticus. Epilepsy Res. 2001; 46:33–8.
Article
111. Ng YT, Kerrigan JF, Rekate HL. Neurosurgical treatment of status epilepticus. J Neurosurg. 2006; 105(5 Suppl):378–81.
Article
112. Dillien P, Ferrao Santos S, van Pesch V, Suin V, Lamoral S, Hantson P. New-onset refractory status epilepticus: more investigations, more questions. Case Rep Neurol. 2016; 8:127–33.
Article
113. Zeiler FA, Zeiler KJ, Teitelbaum J, Gillman LM, West M. VNS for refractory status epilepticus. Epilepsy Res. 2015; 112:100–13.
Article
114. Neligan A, Shorvon SD. Frequency and prognosis of convulsive status epilepticus of different causes: a systematic review. Arch Neurol. 2010; 67:931–40.
Article
115. Sutter R, Marsch S, Fuhr P, Kaplan PW, Ruegg S. Anesthetic drugs in status epilepticus: risk or rescue? A 6-year cohort study. Neurology. 2014; 82:656–64.
Article
Full Text Links
  • KJCCM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr