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journal article·2025-12Open access

Refractory Status Epilepticus and Therapeutic Uncertainties: a Comprehensive Review on Targeting Neuroinflammation and Rationale for Developing a Platform Trial

Shanika Samarasekera, Suneesh Thilak, Asha Patel, Prashant Nasa, Zubair Ahmed, Lorraine Jacques, William J. Scotton, Cyril Chacko, Randeep Mullhi, Ruoling Chen, Vikram Patil, Suresh Renukappa, Tonny Veenith

Advanced Science· Volume 12· Issue 47
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Abstract

Abstract Refractory Status Epilepticus (RSE) is a neurological emergency associated with considerable morbidity and mortality. The molecular mechanisms contributing to neuroinflammation in RSE are increasingly being recognized. Despite its severity, high‐quality and conclusive evidence is lacking for many RSE treatments, especially regarding the optimization of antiseizure medications and emerging immunotherapies. In this manuscript, the use of immunotherapy as a valuable treatment option in RSE is reviewed. The example of Toclizumab is used, its potential efficacy demonstrated by a case series from our center. Traditional clinical trial designs have proven inadequate in efficiently addressing these evidence gaps for this complex and heterogeneous condition. In examining the wider evidence for the use of anti‐inflammatory agents, including early immunotherapy, the scope for adaptive platform trials is explored to be utilized to develop an evidence base in this area. Neuroinflammation plays a role in propagating seizures and associated neuronal injury in RSE; these pathways may be amenable to immunomodulation. In this review, the limitations of existing observational data and the need for efficient, quickly translatable clinical trials are highlighted to evaluate multiple interventions for RSE. Innovative trial designs, such as adaptive platform trials, help generate robust evidence for rapid uptake in RSE.
Source: crossref · Quality: baseline

Research context

Ceramics & glasses

OpenAlex topics: Epilepsy research and treatment · Bacterial Infections and Vaccines · Infectious Encephalopathies and Encephalitis

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Department of Neurology University Hospitals Birmingham NHS Foundation Trust Birmingham West Midlands B15 2TH United Kingdom

Department of Anesthesia Critical Care and Acute Care Medicine The Royal Wolverhampton NHS Trust Wolverhampton West Midlands WV10 0QP United Kingdom

Neuroscience and Ophthalmology Department of Inflammation and Ageing School of Infection University of Birmingham Birmingham West Midlands B15 2TH United Kingdom

Department of Neurosciences University Hospitals Birmingham NHS Foundation Trust Birmingham West Midlands B15 2TH United Kingdom

Department of Neurology The Royal Wolverhampton NHS Trust New Cross Hospital Wolverhampton UK WV1 1LY United Kingdom

Department of Critical Care University Hospitals Birmingham NHS Foundation Trust Birmingham West Midlands B15 2TH United Kingdom

Faculty of Education Health and Wellbeing University of Wolverhampton Wolverhampton West Midlands WV1 1LY United Kingdom

Department of Radiology JSS Medical College JSS AHER Mysuru Karnataka 570020 India

JSS AHER‐ Wolverhampton Centre for Future Health and Policy Innovation Mysuru Karnataka 570020 India

Faculty of Science and Engineering University of Wolverhampton Wolverhampton West Midlands WV1 1LY United Kingdom

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