Super-refractory status epilepticus (SRSE) has high mortality; yet there is limited evidence and no nationally accepted cross-specialty guidelines.Method
A case-based questionnaire on SRSE was distributed to all West Midlands Neurologists and to Intensivists in the tertiary referral hospital. Data collected included: clinician’s confidence, interventions, investigations and need for clinical guidance.Results
Response rate was 57.8% (81 of 140): 15 Neurology Consultants (NC), 27 ICM Consultants (ICC), 13 Neurology Registrars (NR) and 24 ICM Registrars (ICR). Confidence fell with increasing seizure duration. NC were most confident. 22.5% of respondents (33.7% ICC) would use Levetiracetam before anaesthesia 64.3% of NC considered MRI<24 hours mandatory, but only 29.1% of ICC and 8.7% of ICR. 71.4% of NC expected autoimmune screening but only 58.3% of ICC and 30.4% of ICR. NC (64.3%) were more likely than ICC (0%) to consider immunoglobulin, methylprednisolone (64.3% and 0%) and plasma-exchange (42.9% and 4.1%); but less likely to use magnesium (28.6% and 37.5%). 97% would use continuous EEG: 53.9% immediately post-anaesthesia and 43.1% only in SRSE. 95.4% of respondents would welcome clinical guidelines.Conclusion
Neurologists’ and Intensivists’ confidence in and management of SRSE varies. National clinical guidance based best practice would be welcomed by clinicians.