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management of status epilepticus

Sudhir Datar
Status epilepticus (SE) is a medical emergency and presents with either a continuous prolonged seizure or multiple seizures without full recovery of consciousness in between them. The goals of treatment are prompt recognition, early seizure termination, and simultaneous evaluation for any potentially treatable cause. Improved understanding of the pathophysiology has led to a more practical definition. New data have emerged regarding the safety and efficacy of alternative agents, which are increasingly used in the management of these patients...
April 2018: Neurosurgery Clinics of North America
Ben Lawton, Tessa Davis, Henry Goldstein, Andrew Tagg
PURPOSE OF REVIEW: Over the last 2 years, algorithms for the optimal management of status epilepticus have changed, as the medical community has recognized the need to terminate seizures in status in a timely manner. Recent research has evaluated the different choices of benzodiazepine and has given consideration to second-line treatment options. RECENT FINDINGS: There has been a move to examine alternatives to phenytoin (such as levetiracetam and lacosamide) as second-line agents...
March 6, 2018: Current Opinion in Pediatrics
Jeremy Furyk, Robin Ray, Kerriane Watt, Stuart R Dalziel, Ed Oakely, Mark Mackay, Gabriel Dabscheck, Kate Riney, Franz E Babl
PURPOSE: Status epilepticus (SE) is a paediatric emergency with significant morbidity and mortality. Recommendations beyond first line care are not based on high quality evidence. Emergency physicians and neurologists are key stakeholders in managing this condition. A collaborative, widely consulted approach to identifying priorities can help direct limited research funds appropriately. The objectives of this study are to identify consensus research priorities in paediatric SE among experts and health consumers...
February 5, 2018: Seizure: the Journal of the British Epilepsy Association
Patrizia Ambrogini, Maria Cristina Albertini, Michele Betti, Claudia Galati, Davide Lattanzi, David Savelli, Michael Di Palma, Stefania Saccomanno, Desirée Bartolini, Pierangelo Torquato, Gabriele Ruffolo, Fabiola Olivieri, Francesco Galli, Eleonora Palma, Andrea Minelli, Riccardo Cuppini
Seizure-triggered maladaptive neural plasticity and neuroinflammation occur during the latent period as a key underlying event in epilepsy chronicization. Previously, we showed that α-tocopherol (α-T) reduces hippocampal neuroglial activation and neurodegeneration in the rat model of kainic acid (KA)-induced status epilepticus (SE). These findings allowed us to postulate an antiepileptogenic potential for α-T in hippocampal excitotoxicity, in line with clinical evidence showing that α-T improves seizure control in drug-resistant patients...
February 22, 2018: Molecular Neurobiology
Lisa Gillinder, Alexander Lehn, Helen Brown, Sasha Dionisio
OBJECTIVE: The present study aims to determine qualitative outcomes of presentations with acute recurrent seizures or status epilepticus to the emergency department of our institution after the introduction of a new seizure management protocol METHODS: We performed a retrospective analysis on two cohorts of patients for all presentation to the emergency department of our institution. Presentations were reviewed from January to July pre protocol introduction and the same period post protocol...
February 20, 2018: Internal Medicine Journal
K Fatema, M M Rahman, S Akhter, N Akter, S Begum
Non-convulsive status epilepticus (NCSE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in non-convulsive clinical symptoms. This study was done to describe the clinical spectrum, EEG findings and to evaluate the efficacy of different therapeutic agents in children with NCSE in 33 patients from January 2011 to December 2015 period. All patients had EEG before and after treatment. Age range was 6 months to 14 year, 25 were male. Regarding development status, 48% had developmental delay, 21% had normal development, 9% had regression and 21% had both developmental delay and regression...
January 2018: Mymensingh Medical Journal: MMJ
Saad Warraich, Abbas Ali, Atif Nizami, Moiz Bakhiet
RATIONALE: Nonconvulsive status epilepticus (NCSE) is prolonged seizure activity without motor manifestations. Clinically, there are certain examination findings, in addition to elements of history, that help differentiate it from other encephalopathies. When diagnosing NCSE, the physician faces significant difficulties due to inconsistent clinical presentation and somewhat nonspecific electroencephalogram (EEG) criteria. PATIENT CONCERNS: To highlight the problems faced when dealing with such a patient, a case of a 29-year-old male who presented with an altered state of consciousness is put forth for the reader...
February 2018: Medicine (Baltimore)
Dnyaneshwar P Mutkule, S Manimala Rao, Jaydip Ray Chaudhuri, Kunche Rajasri
Status epilepticus is frequently encountered in neuro Intensive Care Units. It is a medical emergency and if not treated promptly can lead to severe brain damage and even death. Here, we present the case of a 18-year-old male with uncontrolled and unrelenting seizures with a rare etiology requiring ketamine infusion for burst suppression as it was resistant to thiopentone and midazolam infusions. The management of this case is presented in detail.
January 2018: Indian Journal of Critical Care Medicine
Mohamed Albakaye, Halima Belaïdi, Fatiha Lahjouji, Leila Errguig, Callixte Kuate, Youssoufa Maiga, Seybou Hassane Diallo, Najib Kissani, Reda Ouazzani
INTRODUCTION: The hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is a rare consequence of febrile seizures during childhood. It is characterized by the presence of prolonged unilateral clonic seizures occurring during febrile illness in a child less than 4years of age. Then, a flaccid unilateral hemiplegia with variable duration occurs. OBJECTIVES: The objective of the study was to describe the clinical, electroencephalogram (EEG), and neuroimaging treatment and outcome of series of cases of HHE syndrome followed for 10years in our clinical neurophysiology department of the specialty hospital of Rabat...
January 26, 2018: Epilepsy & Behavior: E&B
Zhe Zhang, Danhua Zhao, Xiao Zhang, Hui Xiong, Xinhua Bao, Yun Yuan, Zhaoxia Wang
BACKGROUND: Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is a common mitochondrial syndrome. The aim of this study was to conduct a survival analysis based on the clinical features of a Chinese MELAS patient cohort. METHODS: This is a retrospective single-center study. The MELAS patients were followed up for 1-8years (median 4years). The disease severity was evaluated by the modified Rankin Scale (mRS). The survival analysis was performed using Kaplan-Meier analysis and Cox proportional hazards model...
February 15, 2018: Journal of the Neurological Sciences
Robert H Witcher, Michelle M Ramirez
PURPOSE: Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. SUMMARY: A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression...
January 1, 2018: Journal of Pharmacy Practice
Do-Hyung Kim, Hye-Hoon Kang, Minjung Kim, Tae-Won Yang, Oh-Young Kwon, Jung Sook Yeom, Bong Su Kang, Yong Hwan Kim, Young-Soo Kim
Therapeutic hypothermia (TH) has rarely been utilized as an adjunct to anticonvulsants in treating patients with refractory convulsive status epilepticus (CSE). However, determining the effectiveness of TH in CSE is difficult due to the unavoidable use of sedative drugs to manage hypothermia. Additionally, the effectiveness of TH has not been studied in patients with refractory non-convulsive status epilepticus (NCSE). Here, we report the successful use of TH without additional sedative drugs in a patient with temporal lobe epilepsy and refractory NCSE...
December 2017: Journal of Epilepsy Research
Sunit Singhi, Suresh Kumar Angurana
CNS infections in children are medical emergency and are associated with high mortality and morbidity. For diagnosis, a high index of suspicion is required. Clinical assessment should be supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging. Commonly associated life threatening complications include coma, seizure, raised intracranial pressure (ICP), focal deficits, shock, respiratory failure, and fluid and electrolyte abnormalities...
January 15, 2018: Indian Journal of Pediatrics
Amy McTague, Timothy Martland, Richard Appleton
BACKGROUND: Tonic-clonic convulsions and convulsive status epilepticus (currently defined as a tonic-clonic convulsion lasting at least 30 minutes) are medical emergencies and require urgent and appropriate anticonvulsant treatment. International consensus is that an anticonvulsant drug should be administered for any tonic-clonic convulsion that has been continuing for at least five minutes. Benzodiazepines (diazepam, lorazepam, midazolam) are traditionally regarded as first-line drugs and phenobarbital, phenytoin and paraldehyde as second-line drugs...
January 10, 2018: Cochrane Database of Systematic Reviews
Y Uchida, K Terada, Y Madokoro, T Fujioka, M Mizuno, T Toyoda, D Kato, N Matsukawa
BACKGROUND: Cross-sensitivity of rash has been reported between various antiepileptic drugs (AEDs). However, few studies have determined the frequency and management of cross-sensitivity in patients with super-refractory status epilepticus (SRSE). AIMS OF THE STUDY: To examine the optimal AED for treating SRSE with cross-sensitivity. METHODS: We performed a retrospective review of adult patients with SRSE treated at Nagoya City University Hospital, in which we investigated the frequency of cross-sensitivity among patients with SRSE and their clinical and medical profiles...
January 3, 2018: Acta Neurologica Scandinavica
Leena Kämppi, Harri Mustonen, Kaisa Kotisaari, Seppo Soinila
PURPOSE: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. METHOD: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge...
December 28, 2017: Seizure: the Journal of the British Epilepsy Association
Justine Cormier, Carolina B Maciel, Emily J Gilmore
Continuous electroencephalography (cEEG) monitoring is an invaluable tool in the evaluation of encephalopathy and coma in critically ill patients. Marked increases in cEEG monitoring, coinciding with several societal guideline statements in the last decade, have allowed earlier detection and treatment of clearly harmful patterns, including nonconvulsive seizures (NCSz) and nonconvulsive status epilepticus (NCSE). However, it has also unmasked a range of EEG patterns of less clear clinical significance, with some more "malignant" than others given their potential association with increased neuronal stress and secondary brain injury...
December 2017: Seminars in Respiratory and Critical Care Medicine
Rebecca J Mitchell, Geoffrey Herkes, Armin Nikpour, Andrew Bleasel, Patti Shih, Sanjyot Vagholkar, Frances Rapport
This study examined the health service utilization and hospital treatment cost of individuals with epilepsy by age group, mortality within 30days, and surgical outcomes for individuals with refractory epilepsy in New South Wales (NSW), Australia. A retrospective examination of linked hospitalization and mortality data for individuals hospitalized with a diagnosis of epilepsy during 2012-2016. Hospitalized incidence rates per 1000 population were calculated, and negative binomial regression was used to examine temporal trends...
February 2018: Epilepsy & Behavior: E&B
Tanya J W McDonald, Mackenzie C Cervenka
The current review highlights the evidence supporting the use of ketogenic diets in the management of drug-resistant epilepsy and status epilepticus in adults. Ketogenic diet variants are compared and advantages and potential side effects of diet therapy are discussed.
November 2017: Epilepsy Currents
Boulenouar Mesraoua, Dirk Deleu, Hassan Al Hail, Faisal Ibrahim, Gayane Melikyan, Hassan Al Hussein, Rajvir Singh, Basim Uthman, Leopold Streletz, Peter W Kaplan, Heinz Gregor Wieser
Objective: This study reports the prevalence of Nonconvulsive Status Epilepticus (NCSE) in patients with altered mental status (AMS), and describes the clinical presentation, etiology, neurophysiological findings, neuroimaging, treatment, and outcome of NCSE in Qatar. Recording duration of continuous EEG monitoring was also discussed. Methods: This was a 3-year, prospective, hospital-based study involving patients with AMS and continuous EEG monitoring admitted to the Emergency and ICUs of Hamad Hospital, Qatar...
2017: Journal of Drug Assessment
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