Super Refractory Status Epilepticus: A Case Report from Livingstone Central Hospital, Zambia

Abstract

Background: Status Epilepticus (SE) is defined as more than five minutes of persistent seizure activity without full recovery of consciousness in between the seizures. If SE fails to respond to two antiepileptic drugs, it is called refractory status epilepticus (RSE) and if it continues or recurs 24 hours after anesthesia, it is called super refractory status epilepticus (SRSE). We present a case of 22 years old Zambian nursing student who presented with first episode of generalized tonic-clonic seizures which later turned out to be SRSE. This case has been presented due to the rarity of this condition. To the best of our knowledge this is the first documented case of SRSE in Zambia.
Objective: To familiarize the clinicians through this case about SRSE and challenges in its diagnosis and the management in resource poor Zambian health settings.
Case History: A 22 years old male nursing student with first episode of generalized tonic clonic seizures brought into the medical emergency of Livingstone Central Hospital. He was treated with 60mg of diazepam but fits continued and patient was transferred to ICU, where he was treated with phenobarbitone infusion with no effect until he was intubated and given general anesthesia with thiopental infusion. After 36 hours, he was extubated, and fits returned soon. His fits finally came under control after treatment with sodium valproate, levitracetam and lorazepam His FBC, LFTs, RBS, electrolytes, CT scan of brain and MRI of brain did not show any abnormality.
Conclusion: Though SRSE is a rare condition but once it presents, it becomes difficult to manage. All cases of SE should be treated with urgency to prevent them from becoming RSE and SRSE.