Zebras Seize the Day: Rare Causes of Status Epilepticus Across the Continuum of Critical Care

Status epilepticus (SE) is a common neurologic emergency associated with a high risk of morbidity and mortality. Convulsive SE (CSE) affects approximately 17 to 23 of 100,000 children1 and 9 to 40 of 100,000 adults2 in the United States and Europe each year. CSE is associated with a mortality of 3% to 5% in children3 and up to 30% in adults.2 Survivors often have cognitive and other neurologic sequelae.2,3 Early and effective treatment may halt the evolution of SE. However, not all patients will respond to first- and second-line antiseizure medications (ASMs). When this happens, the patient is generally considered to be in refractory SE. A large pediatric series suggests that this occurs in as many as one-fifth of episodes of SE.4 Super-refractory SE (SRSE) occurs when SE continues or recurs 24 hours or more after the initiation of