Neurology® Podcast Super Refractory Status Epilepticus Diagnosis, Management, and Prognostication
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Nov 10, 2025 Dr. Matthew Ryan Woodward, a Neurointensivist at the University of Maryland, dives deep into the complexities of status epilepticus. He discusses the critical transition to refractory and super-refractory states, shedding light on treatment implications. Matthew reveals insights from an international survey on real-world management variability, highlighting differences in diagnostics and prognostication. The conversation also touches on ableism in healthcare and strategies for better multidisciplinary collaboration in treatment practices.
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Why Status Becomes Super-Refractory
- Super-refractory status epilepticus (SRSE) reflects ongoing seizures after 24 hours of anesthetic infusion or when seizures recur on wean.
- Both the underlying cause severity and seizure-driven cellular changes combine to make SRSE harder to treat.
Trainee Experience Sparked the Study
- Matt Woodward describes his trainee experience noticing wide variability in SRSE care and limited guidance.
- He worked on a case series using electroconvulsive therapy as a salvage treatment and found little clear evidence to guide practice.
Survey Focus: Three Practical Domains
- Investigate SRSE across three domains: anti-seizure medications, diagnostic workup, and prognosis timing/content.
- Ask about IV anesthetics, nonpharmacologic adjuncts, underlying-cause evaluation, and when to prognosticate.