To evaluate the efficacy and safety of intra thecal dexamethasone in the acute phase of super refractory status epilepticus, in resource -limited settings

We conducted a retrospective study from 2023 to 2025, children aged 1 month to 18years  fulfilling supra refractory status epilepticus with varied etiologies, who received intrathecal dexamethasone as an early immunomodulatory therapy were enrolled. Clinicodemographic data, inflammatory markers, neuroimaging  were included. Severity at admission, assessed using END IT scores and outcomes like time of cessation of electrographic seizures, achievement of burst suppression, decrease of burden of anti seizure medication and outcomes at discharge were measured.

Out of 13 patients enrolled, the median age was 4 years. The study included children with a myriad of presentations categorized as definite, possible immune mediated and less likely immune mediated encephalitis. Based on the END-IT score, majority (69%) had a score of 5, indicating severe disease. Post intra thecal dexamethasone, clinical and electrographic parameters were monitored. Time of electrographic cessation in less than 48 hours was observed in 78% and all (100%) achieved burst suppression on EEG and significant reduction in anti seizure medication burden by the time of discharge. In children with immune mediated etiologies the overall response to intrathecal dexamethasone was favorable compared to non immune mediated. 

Intrathecal dexamethasone is effective therapy when used in the early stage of supra refractory status epilepticus associated with immune medicated encephalitis. It is associated with early cessation of electrographic seizures and decrease antiseizure burden with favorable outcome.