{
  "abstract": "Background and objectives\n\nThe SUPER-refractory status epilepticus (SE) after Cardiac Arrest Treatment (SUPER-CAT) study evaluated the efficacy and safety of dual antiglutamate therapy (combined AMPA and NMDA receptor blockade) in patients with super-refractory SE (SRSE) after cardiac arrest and without unfavorable prognostic indicators.Methods\n\nMulticenter cohort study including patients with postanoxic SRSE meeting the following criteria: bilaterally preserved N20 cortical responses, intact pupillary reflexes, and absence of generalized periodic discharges. Patients treated with dual antiglutamate therapy (DUAL; ketamine 1.5-7.5 mg/kg/h for 3 days plus perampanel 6-12 mg/d for 5 days with tapering) were compared with patients receiving other combinations of antiseizure and anesthetic agents (OTHERS). The primary outcome was resolution of SE. Secondary outcomes included awakening to follow commands and good neurologic outcome at 6 months (modified Rankin Scale 0-3) in patients with fewer than 2 unfavorable multimodal prognostic indicators and 6-month mortality for the entire cohort. Safety analysis included in-hospital mortality and potentially treatment-related adverse events. Patients treated with single antiglutamate agents were described separately.Results\n\nBetween May 2012 and May 2025, 95 of 1,352 consecutive post-cardiac arrest intensive care unit patients met inclusion criteria (mean age 66, interquartile range 55-73; 41% female; DUAL = 43; OTHERS = 41; single antiglutamate = 11). Compared with OTHERS, DUAL was associated with a higher rate of SE resolution (84% vs 49%; OR 5.4; 95% CI 1.9-14.9; p = 0.001), a greater likelihood of awakening before discharge (56% vs 32%; OR 2.7; 95% CI 1.0-7.3; p = 0.053) and lower 6-month mortality (52% vs 74%; OR 0.37; 95% CI 0.15-0.97; p = 0.043). A trend toward better 6-month neurologic outcome was observed in the DUAL group (39% vs 25%; OR 1.89; 95% CI 0.64-5.56; p = 0.245). Reversible cholestatic liver injury occurred more frequently in DUAL group, compared with OTHERS (77% vs 27%; OR 9.00; 95% CI 3.34-24.19; p < 0.001).Discussion\n\nIn patients with postanoxic SRSE without unfavorable prognostic indicators, dual antiglutamate therapy was highly effective in resolving SE and was associated with improved short-term clinical outcomes.Trial registration information\n\nClinicalTrials.gov NCT05756621.",
  "abstract_shown": true,
  "affiliations": [
    "Epilepsy Center, Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.",
    "Department of Medicine and Surgery, University of Milano-Bicocca, Italy.",
    "Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.",
    "Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.",
    "Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.",
    "PhD Program in Neuroscience, University of Milano-Bicocca, Milano, Italy.",
    "Neurophysiology Unit and Epilepsy Centre, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Italy.",
    "Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Italy.",
    "Department of Neurology and Intensive Care, Santa Chiara Hospital, Azienda sanitaria universitaria integrata del Trentino (Asuit), Trento, Italy.",
    "Epilepsy Unit, IRCCS Mondino Foundation, Pavia, Italy.",
    "S.C. Neurologia, Ospedale Centrale di Bolzano, Italy.",
    "S.C. Neurologia, Ospedale Brotzu Cagliari, Italy.",
    "Neurology Unit, Department of Neurosciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.",
    "Division of Anesthesia and Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.",
    "Unit of Neurology, University Hospital of Parma, Italy.",
    "S.C. Neurologia, Ospedale M. Bufalini Cesena, Italy.",
    "CRUISE Research Center, Dipartimento di Scienze della Salute, Università Magna Graecia di Catanzaro, Italy; and.",
    "S.C. Neurofisiologia, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy."
  ],
  "article_type": "research article",
  "arxiv": null,
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  "bibtex": "https://research.draconitic.com/paper/5147c7bj21e4t.bib",
  "cited_by": 0,
  "doi": "10.1212/wnl.0000000000218565",
  "fulltext_url": "https://europepmc.org/articles/PMC13651901",
  "id": "5147c7bj21e4t",
  "issns": [
    "0028-3878",
    "1526-632X"
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  "landing_url": "https://europepmc.org/article/MED/42837646",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2738|Epilepsy research and treatment"
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  "openalex": "W7220665275",
  "pdf_url": "https://europepmc.org/articles/PMC13651901?pdf=render",
  "pmcid": "PMC13651901",
  "pmid": "42837646",
  "published": "2026-10-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5147c7bj21e4t.ris",
  "sources": [
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      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42837646",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42837646"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2738|Epilepsy research and treatment",
      "subfield": "psychiatry"
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  ],
  "title": "Dual Antiglutamate Therapy in Super-Refractory Status Epilepticus After Cardiac Arrest (SUPER-CAT Study).",
  "title_text": "Dual Antiglutamate Therapy in Super-Refractory Status Epilepticus After Cardiac Arrest (SUPER-CAT Study).",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/5147c7bj21e4t",
  "venue": "Neurology",
  "versions": []
}