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management of status epilepticus

Santoshi Billakota, Saurabh R Sinha
INTRODUCTION: Continuous EEG (cEEG) monitoring is used in the intensive care unit (ICU) setting to detect seizures, especially nonconvulsive seizures and status epilepticus. The utility and impact of such monitoring in non-ICU patients are largely unknown. METHODS: Hospitalized patients who were not in an ICU and underwent cEEG monitoring in the first half of 2011 and 2014 were identified. Reason for admission, admitting service (neurologic and nonneurologic), indication for cEEG, comorbid conditions, duration of recording, EEG findings, whether an event/seizure was recorded, and impact of EEG findings on management were reviewed...
October 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Jacques Theitler, Daniella Dassa, Revital Gandelman-Marton
BACKGROUND: The electroencephalogram (EEG) can support the diagnosis of epilepsy, diagnose nonconvulsive status epilepticus, and aid in the classification of epileptic seizures. Its contribution to the diagnosis of other medical conditions or to decision making in other clinical situations was not established. Practically, EEG labs frequently encounter EEG referrals that are not based on current recommendations. OBJECTIVES: To assess the value of inpatient EEG in medical decision making...
October 6, 2016: European Journal of Clinical Investigation
Gaurav Bhaskar Nigam, Sachin Suresh Babu, C Sudhir Peter, C Shobhna Peter
Predicting the neurological outcome in survivors of cardiorespiratory arrest is difficult. A distinction has been made between acute and chronic posthypoxic myoclonus, called myoclonic status epilepticus and Lance-Adams syndrome (LAS), respectively, with the acute condition carrying a bad prognosis. Here, we report a case of a 37-year-old female who developed seizures after a successful cardiopulmonary resuscitation. The available literature on such cases is very rare and has generally mentioned a poor outcome...
September 2016: Indian Journal of Critical Care Medicine
Johan Zelano, Elinor Ben-Menachem
Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices...
October 14, 2016: Expert Opinion on Pharmacotherapy
Michael Billington, Osama R Kandalaft, Imoigele P Aisiku
Seizures are a common presentation in the prehospital and emergency department setting and status epilepticus represents an emergency neurologic condition. The classification and various types of seizures are numerous. The objectives of this narrative literature review focuses on adult patients with a presentation of status epilepticus in the prehospital and emergency department setting. In summary, benzodiazepines remain the primary first line therapeutic agent in the management of status epilepticus, however, there are new agents that may be appropriate for the management of status epilepticus as second- and third-line pharmacological agents...
August 23, 2016: Journal of Clinical Medicine
Edilberto Amorim, Jon C Rittenberger, Julia J Zheng, M Brandon Westover, Maria E Baldwin, Clifton W Callaway, Alexandra Popescu
OBJECTIVE: Hypoxic brain injury is the largest contributor to disability and mortality after cardiac arrest. We aim to identify electroencephalogram (EEG) characteristics that can predict outcome on cardiac arrest patients treated with targeted temperature management (TTM). METHODS: We retrospectively examined clinical, EEG, functional outcome at discharge, and in-hospital mortality for 373 adult subjects with return of spontaneous circulation after cardiac arrest...
August 20, 2016: Resuscitation
Raquel Farias-Moeller, Luca Bartolini, Archana Pasupuleti, R D Brittany Cines, Amy Kao, Jessica L Carpenter
BACKGROUND: Super-refractory status epilepticus (SRSE) ensues when there is no improvement of seizure control in response to anesthetic therapy or seizure recurrence after reduction of anesthetic agents. There is no consensus on standard of care for SRSE. Ketogenic diet (KD) has reported success, but technical challenges exist including inability to feed patients, concomitant steroid use, acidotic states, and lack of dieticians with experience. The optimal protocol for KD is yet to be determined...
August 23, 2016: Neurocritical Care
Étienne de Montmollin, Sophie Demeret, Noëlle Brulé, Marie Conrad, Frédéric Dailler, Nicolas Lerolle, Jean-Christophe Navellou, Carole Schwebel, Mikaël Alves, Martin Cour, Nicolas Engrand, Jean-Marie Tonnelier, Eric Maury, Stéphane Ruckly, Géraldine Picard, Véronique Rogemond, Éric Magalhaes, Tarek Sharshar, Jean-François Timsit, Jérôme Honnorat, Romain Sonneville
RATIONALE: Encephalitis due to anti-N-methyl-D-aspartate receptor (NMDAR) antibodies is the leading cause of immune-mediated encephalitis. There is limited data on intensive care unit (ICU) management of these patients. OBJECTIVES: To identify prognostic factors of good neurologic outcome in patients admitted to an ICU with anti-NMDAR encephalitis. METHODS: Observational multicenter study of all consecutive adult patients diagnosed with anti-NMDAR encephalitis, admitted to an ICU between 2008 and 2014...
August 23, 2016: American Journal of Respiratory and Critical Care Medicine
Lia D Ernst, Eilis A Boudreau
PURPOSE OF REVIEW: Recent advances in our understanding of seizure generation have resulted in modified recommendations for when seizure treatment should be initiated, revisions to our definition of status epilepticus, and new pharmacological and neuromodulatory therapies. The goal of this review is to provide the anesthesiologist with an overview of the advancements they are most likely to encounter while providing clinical care. RECENT FINDINGS: There have been recent modifications to seizure definitions and treatment recommendations...
October 2016: Current Opinion in Anaesthesiology
James J Riviello
The important question that often emerges in the clinic is how aggressive the therapy for nonconvulsive status epilepticus and electrical status epilepticus in sleep ought to be and how continuous the discharges in each of these 2 entities should be before therapy is aimed at them. Additionally, as the use of electroencephalographic monitoring continues to expand to include the clinic and intensive care unit populations, it is important to identify epileptiform patterns that warrant identification and treatment...
May 2016: Seminars in Pediatric Neurology
Tapan Kavi, Donna Molaie, Michael Nurok, Axel Rosengart, Shouri Lahiri
Introduction. Mild hypotension is a well-recognized complication of intravenous pentobarbital; however fulminant cardiopulmonary failure has not been previously reported. Case Report. A 28-year-old woman developed pentobarbital-induced cardiopulmonary failure that was successfully treated with maximal medical management including arteriovenous extracorporeal membrane oxygenation. She made an excellent cardiopulmonary and neurological recovery. Discussion and Conclusion. Pentobarbital is underrecognized as a potential cause of myocardial stunning...
2016: Case Reports in Critical Care
Sarah K B Bick, Saef Izzy, Daniel B Rubin, Sahar F Zafar, Eric S Rosenthal, Emad N Eskandar
BACKGROUND: Herpes simplex virus (HSV) is a common cause of viral encephalitis that can lead to refractory seizures. The primary treatment of HSV encephalitis is with acyclovir; however, surgery sometimes plays a role in obtaining tissue diagnosis or decompression in cases with severe mass effect. We report a unique case in which anterior temporal lobectomy was successfully used to treat refractory status epilepticus in HSV encephalitis. METHODS: Case report and review of the literature...
July 29, 2016: Neurocritical Care
Fenella Jane Kirkham
Pediatric neurology relies on ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging. CT prevails in acute neurologic presentations, including traumatic brain injury (TBI), nontraumatic coma, stroke, and status epilepticus, because of easy availability, with images of diagnostic quality, e.g., to exclude hemorrhage, usually completed quickly enough to avoid sedation. Concerns over the risks of ionizing radiation mean re-imaging and higher-dose procedures, e.g., arteriography and venography, require justification...
2016: Handbook of Clinical Neurology
Daniela Pogliani, Annalisa Pozzi, Claudio Laudi, Laura Rimoldi, Elisabetta Sogni, Piera Farfaglia, Carmela Figliola, Carlo Jovane, Davide Zarcone, Enrico Caretta
The management of the pain therapy (ischemic pain, neoplastic pain) in hemodialysis patients has become a frequent challenge in the last years. These patients often require the prescription of major analgesic drugs such as Opioids like Fentanyl, in order to control the pain. It is necessary to pay attention to the correct dosage and to the half life of these drugs, that results prolonged in the chronic renal insufficiency. The main side effect of opioids is respiratory depression which is well known, however, up to date, there is a lack of reports about other less frequent side effects, such as epilepsy or status epilepticus, in the literature...
May 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Stephane Legriel, Fernando Pico, Yves-Roger Tran-Dinh, Virginie Lemiale, Jean-Pierre Bedos, Matthieu Resche-Rigon, Alain Cariou
Convulsive status epilepticus (CSE) is a major medical emergency associated with a 50 % morbidity rate. CSE guidelines have recommended prompt management for many years, but there is no evidence to date that they have significantly improved practices or outcomes. Developing neuroprotective strategies for use after CSE holds promise for diminishing morbidity and mortality rates. Hypothermia has been shown to afford neuroprotection in various health conditions. We therefore designed a trial to determine whether 90-day outcomes in mechanically ventilated patients with CSE requiring management in the intensive care unit (ICU) are improved by early therapeutic hypothermia (32-34 °C) for 24 h with propofol sedation...
December 2016: Annals of Intensive Care
Itaru Hayakawa, Sahoko Miyama, Nobuaki Inoue, Hiroshi Sakakibara, Hiroshi Hataya, Toshiro Terakawa
Pediatric convulsive status epilepticus with fever is common in the emergency setting but leads to severe neurological sequelae in some patients. To explore the epidemiology of convulsive status epilepticus with fever, a retrospective cohort covering all convulsive status epilepticus cases with fever seen in the emergency department of a tertiary care children's hospital were consecutively collected. Of the 381 consecutive cases gathered, 81.6% were due to prolonged febrile seizure, 6.6% to encephalopathy/encephalitis, 0...
September 2016: Journal of Child Neurology
Elaine C Wirrell
Dravet syndrome is among the most challenging electroclinical syndromes. There is a high likelihood of recurrent status epilepticus; seizures are medically refractory; and patients have multiple co-morbidities, including intellectual disability, behaviour and sleep problems, and crouch gait. Additionally, they are at significant risk of sudden unexplained death. This review will focus predominantly on the prophylactic medical management of seizures, addressing both first-line therapies (valproate and clobazam) as well as second-line (stiripentol, topiramate, ketogenic diet) or later options (levetiracetam, bromides, vagus nerve stimulation)...
June 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Miriam Schneider, Petrus J de Vries, Kai Schönig, Veit Rößner, Robert Waltereit
Epilepsy is a major risk factor for autism spectrum disorder (ASD) and complicates clinical manifestations and management of ASD significantly. Tuberous sclerosis complex (TSC), caused by TSC1 or TSC2 mutations, is one of the medical conditions most commonly associated with ASD and has become an important model to examine molecular pathways associated with ASD. Previous research showed reversal of autism-like social deficits in Tsc1 (+/-) and Tsc2 (+/-) mouse models by mammalian target of rapamycin (mTOR) inhibitors...
June 4, 2016: European Archives of Psychiatry and Clinical Neuroscience
Haseeb Hassan, Keni Ravish Rajiv, Ramshekhar Menon, Deepak Menon, Muralidharan Nair, Ashalatha Radhakrishnan
Status epilepticus is a neurological emergency with significant morbidity and mortality. This study describes the clinical profile, treatment, and predictors of outcome of status epilepticus in a tertiary referral centre in a developing country and aims to highlight the similarities and differences from data available from the western world. A retrospective analysis of data of patients treated for status epilepticus was conducted from prospectively maintained records, between January 2000 and September 2010...
June 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Jonathan E Kurz, Samuel M Poloyac, Nicholas S Abend, Anthony Fabio, Michael J Bell, Mark S Wainwright
OBJECTIVES: Early posttraumatic seizures may contribute to worsened outcomes after traumatic brain injury. Evidence to guide the evaluation and management of early posttraumatic seizures in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring, seizure prophylaxis, and the management of early posttraumatic seizures to provide essential information for trial design and the development of posttraumatic seizure management pathways...
July 2016: Pediatric Critical Care Medicine
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