A 29-year-old female presented to the intensive care unit with refractory status epilepticus. Despite treatment with anticonvulsants and sedation, she continued to have EEG evidence of seizure activity that terminated only with volatile anaesthetic agents. There was serological evidence of exposure to a flavivirus. In the UK the only endemic flavivirus is Louping ill, which is closely related to tick-borne encephalitis. It was likely that this was the cause. She remained on intensive care for almost six months and failed to regain consciousness.
Centre for Food Security and Public Health, State University of Iowa. Louping Ill Ovine Encephalomyelitis, Infectious Encephalomyelitis of Sheep, Trembling—Ill.http://www.cfsph.iastate.edu/Factsheets/pdfs/loupingill.pdf August 24, 2009. Accessed August 2012.
4.
MayerSAClaassenJLokinJ. Refractory status epilepticus: frequency, risk factors, and impact on outcome. Arch Neurol2002;59: 205–10.
5.
MusialowiczTMervaalaEKälviäinenR. Can BIS monitoring be used to assess the depth of propofol anaesthesia in the treatment of refractory status epilepticus. Epilepsia2010;51: 1580–86.
6.
MirsattariSMSharpeMDYoungGB. Treatment of refractory status epilepticus with inhalational anesthetic agents. Arch Neurol2004;61: 1254–59.
7.
FugateJEBurnsJDWijdicksEF. Prolonged high-dose isoflurane for refractory status epilepticus: is it safe?Anesth Analg2010;111: 1520–24.
8.
MeierkordHBoonPEngelsenB. EFNS guideline on the management of status epilepticus in adults. Eur J Neurol2010;17: 348–55.
9.
CooperADBrittonJWRabinsteinAA. Functional and cognitive outcome in prolonged refractory staus epilepticus. Arch Neurol2009;66: 1505–09.
10.
LegrielSAzoulayEResche-RigonM. Functional outcome after convulsive status epilepticus. Crit Care Med2010;38: 2295–2303.
11.
RossettiAMilliganTAVulliémozS. A randomized trial for the treatment of refractory status epilepticus. Neurocrit Care2011;14: 4–10.
12.
HotlkampM. Treatment strategies for refractory status epilepticus. Curr Opin Crit Care2011;17: 94–100.
13.
ShorvonS. Super-refractory status epilepticus: an approach to therapy in this difficult situation. Epilepsia2011;52 (Suppl 8):53–56.
14.
BrophyGMBellRClaassenJ. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care2012;17: 3–23.
15.
ShorvonSFerlisiM. The outcome of therapies in refractory and super-refractory convulsive status epilepticus and recommendations for therapy. Brain2012;135: 2314–28.
16.
BleckTP. Less common aetiologies of status epilepticus. Epilepsy Curr2010;2: 31–33.
