Super-refractory status epilepticus (SRSE) is a life-threatening condition characterized by the persistence or recurrence of seizures despite the use of first- and second-line antiepileptic drugs and the continuous infusion of anesthetics for more than 24 hours. This has always been a challenge for the physician, given the high mortality and morbidity related to this condition. Unfortunately, there are currently no definitive data to guide the therapy, since most of the therapeutic approaches regarding SRSE come from anecdotal evidence. Here, we present a case report of long-persisting new-onset SRSE treated with unconventional therapies recently reported to be successful such as ketamine, ketogenic diet, and tocilizumab, that could have played an important role in the management of this patient. A review of the literature regarding those is also included. SRSE has been reported to have long hospital length of stay, with a small percentage of patients returning to baseline functional status. Moreover, recent evidence showed that functional and cognitive outcome could depend on seizure duration, so prolonged duration of epileptic activity with abnormalities on the magnetic resonance imaging (MRI) could be seen as a reason to discontinue treatment. However, despite many weeks of seizures and a noncomforting MRI, our patient was discharged with a good functional status.

中文翻译：

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超难治性癫痫持续状态的非常规治疗应用：病例报告和文献综述

超难治性癫痫持续状态 (SRSE) 是一种危及生命的疾病，其特征是尽管使用了一线和二线抗癫痫药物并连续输注麻醉剂超过 24 小时，但癫痫仍持续存在或复发。鉴于与这种情况相关的高死亡率和发病率，这对医生来说一直是一个挑战。不幸的是，目前没有明确的数据来指导治疗，因为大多数关于 SRSE 的治疗方法都来自轶事证据。在这里，我们提供了一个病例报告，该病例报告使用最近报道成功的非常规疗法（例如氯胺酮、生酮饮食和托珠单抗）治疗了长期持续的新发 SRSE，这些疗法可能在该患者的治疗中发挥重要作用。还包括对有关这些文献的回顾。据报道，SRSE 住院时间长，一小部分患者恢复到基线功能状态。此外，最近的证据表明，功能和认知结果可能取决于癫痫发作持续时间，因此延长癫痫活动持续时间并伴有磁共振成像 (MRI) 异常可被视为停止治疗的原因。然而，尽管有数周的癫痫发作和不舒服的 MRI，我们的患者仍以良好的功能状态出院。因此，长时间的癫痫活动持续时间与磁共振成像 (MRI) 异常可被视为停止治疗的原因。然而，尽管有数周的癫痫发作和不舒服的 MRI，我们的患者仍以良好的功能状态出院。因此，长时间的癫痫活动持续时间与磁共振成像 (MRI) 异常可被视为停止治疗的原因。然而，尽管有数周的癫痫发作和不舒服的 MRI，我们的患者仍以良好的功能状态出院。