Pyridoxine in Management of Super-Refractory Status Epilepticus: A Case Report

AIM: To raise awareness on super-refractory status epilepticus and propose the addition of pyridoxine to our status epilepticus management guidelines given its safety profile. CASE: V.E was a 9year female with Cerebral palsy from Kernicterus that was referred to our facility with acute seizures that persisted despite benzodiazepines. Significant past medical history was that of a single afebrile seizure two years earlier but she has been otherwise stable. Her initial work up excluded sepsis, while serum magnesium, electrolytes, renal and liver functions remained normal. Brain MRI revealed no acute changes. She continued to convulse beyond the first week of admission necessitating ICU admission and continuous thiopental sodium infusion with no response. RESULTS: Super-refractory status epilepticus (SRSE) is status epilepticus that has recurred or persisted for more than 24 hours after initiation of intravenous anaesthetic medication. It carries a high risk of morbidity and mortality. Our patient's seizures continued for over a week and stopped only after commencement of pyridoxine. CONCLUSION: Super-refractory seizure warrants meticulous care due to its high fatalities and the addition of a simple non-toxic vitamin may be life-saving.
Keywords: pyridoxine, super-refractory status epilepticus, status epilepticus guideline, continuous anaesthetic infusion