Comparing Disclosure and Supports used by Higher-Education Students with Neurodivergent or Mental Health Conditions.

Convulsive status epilepticus (SE) is the most common neurological emergency in childhood, with an annual incidence of up to 42 per 100,000 children []. Mortality in pediatric convulsive SE is approximately 3 % in the short term [] and 7 % to 11 % in the long term []. Furthermore, lifelong sequelae, including cognitive impairment, behavioral problems, and subsequent epilepsy, are common and have a major negative impact on the quality of life of the survivors []. Current guidelines recommend a stepwise treatment paradigm for SE, with benzodiazepines (BZDs) as the first-line therapy, followed by sequential addition of antiseizure medications (ASMs) as the second-line therapy if SE persists []. When SE continues despite treatment with first- and second-line agents, it is considered refractory (RSE) [], for which aggressive treatment using general anesthetics (GAs) as the third-line therapy is recommended []. Commonly used GAs in this setting include midazolam, propofol, barbiturates, and ketamine []. However, observational studies in adults suggested that the use of GAs was associated with worse outcomes, including increased risk of death and infection [, , ]. These studies were limited by their retrospective nature which has inherent bias, including a tendency for patients with more severe RSE to receive GAs []. In addition, there is concern that early repeated exposure of the developing brain to GAs might lead to impaired neurodevelopment and long-term cognition deficits [, , ]. Previous prospective randomized controlled clinical trials comparing the different GAs or between GAs and non-anesthetic treatments have failed to complete owing to practical constraints such as insufficient recruitment and ethical concerns []. We aimed to address these knowledge gaps by conducting a randomized controlled animal study. We compared the efficacy of five different GAs in terminating RSE and their effects on mortality and neurological prognosis in a rat model of RSE. These agents are commonly used in the operating room (OR) and intensive care unit (ICU). Based on the findings, we proposed a multi-dimensional model to aid in selecting the optimal GA for RSE that integrated the efficacy, safety, and neurological prognosis.