Prolonged Magnesium Sulphate Infusion in the Management of Super-Refractory Status Epilepticus in a Probable Anti-GABA-B Autoimmune Encephalitis

Super refractory status epilepticus (SRSE) is a condition associated with high rates of mortality and morbidity. We report the treatment protocol of magnesium sulphate infusion adapted for the management of a case of super refractory status epilepticus that lasted for 4 weeks. A young lady presented in altered sensorium with a history of fever followed by uncontrolled seizures of 2 weeks duration. Her serum tested weakly positive for GABA-B receptor antibody. Her seizures were not controlled despite being on multiple antiepileptics and anesthetic induction. Intravenous magnesium infusion was initiated and serum magnesium was titrated up to a final target concentration of 3.8-6.5 mg/dl. Seizure control was achieved after 11 days of the infusion. This case is the longest reported successful use of magnesium sulfate infusion for control of super refractory status epileptics.