Table 3.

Expediting ICU stays for patients with “Super Duper” refractory status epilepticus

Consider new treatment: immunotherapy, ketamine, surgery, ketogenic diet, various types of stimulation.

Consider prolonged phenobarbital/lorazepam—covered withdrawal of highly sedating drugs (can be tapered out of ICU, or even out of hospital).

Try non-sedating ASDs first when treatment must be intensified, e.g., for relapses.

Assure adequate doses of concomitant non-sedating ASDs (two or more) when tapering highly sedating drugs.

Surveillance for and management of infection, hematologic problems, organ failure.

Tolerate a few seizures per day, especially if nonconvulsive, or focal, or brief (under a few minutes each); not generalized convulsions.

Do not increase treatment for isolated or non-rapid periodic epileptiform discharges.