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https://www.readbyqxmd.com/read/29320603/drug-management-for-acute-tonic-clonic-convulsions-including-convulsive-status-epilepticus-in-children
#1
REVIEW
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
https://www.readbyqxmd.com/read/29318511/midazolam-efficacy-against-acute-hydrogen-sulfide-induced-mortality-and-neurotoxicity
#2
Poojya Anantharam, Dong-Suk Kim, Elizabeth M Whitley, Belinda Mahama, Paula Imerman, Piyush Padhi, Wilson K Rumbeiha
Hydrogen sulfide (H2S) is a colorless, highly neurotoxic gas. It is not only an occupational and environmental hazard but also of concern to the Department of Homeland Security for potential nefarious use. Acute high-dose H2S exposure causes death, while survivors may develop neurological sequelae. Currently, there is no suitable antidote for treatment of acute H2S-induced neurotoxicity. Midazolam (MDZ), an anti-convulsant drug recommended for treatment of nerve agent intoxications, could also be of value in treating acute H2S intoxication...
January 9, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/29306558/high-dose-phenobarbitone-coma-in-pediatric-refractory-status-epilepticus-a-retrospective-case-record-analysis-a-proposed-protocol-and-review-of-literature
#3
Sheffali Gulati, Vishal Sondhi, Biswaroop Chakrabarty, Prashant Jauhari, Rakesh Lodha, Jhuma Sankar
BACKGROUND: Ongoing refractory status epilepticus is associated with significant morbidity and mortality. Therapeutic coma induction with midazolam, thiopentone, phenobarbitone or propofol is indicated when conventional antiepileptics fail to abort seizure. Of these, the most extensively studied is midazolam. Amongst the remaining three, phenobarbitone has the most favourable pharmacological profile, but has not been studied adequately, more so in the pediatric age group. The current retrospective case records analysis is an attempt to describe use of phenobarbitone coma in pediatric refractory status epilepticus...
January 3, 2018: Brain & Development
https://www.readbyqxmd.com/read/29303424/seizing-the-opportunity-exploring-barriers-to-use-of-transmucosal-midazolam-in-hospice-patients
#4
Samuel J Perna, James M Rhinewalt, Erin R Currie
BACKGROUND: Status epilepticus seizures are distressing events for hospice and palliative care patients. Currently, rectal diazepam is the only abortive therapy approved by the U.S. Food and Drug Administration for seizures occurring out of hospital. However, transmucosal (buccal and intranasal) midazolam hydrochloride is a less expensive, equally effective, and a more socially acceptable alternative. OBJECTIVE: To explore the use of transmucosal midazolam in out-of-hospital hospice patients in the State of Alabama...
January 5, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29289522/effect-of-rescue-medication-on-seizure-duration-in-non-institutionalized-children-with-epilepsy
#5
Federico Vigevano, Fenella J Kirkham, Bernd Wilken, Miquel Raspall-Chaure, Regina Grebla, Dawn Lee, Tamara Werner-Kiechle, Lieven Lagae
OBJECTIVES: Characterize the real-world management of and outcomes for children with epilepsy receiving rescue medication for prolonged acute convulsive seizures (PACS) in the community. METHODS: PERFECT-3 (Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy 3) was a European, retrospective observational study. Eligible patients were non-institutionalized children with epilepsy aged 3-16 years who had experienced ≥1 PACS in the past year and had ≥1 currently prescribed PACS rescue medication...
August 2, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/29245268/posterior-reversible-encephalopathy-syndrome-after-postpartum-hemorrhage-and-uterine-artery-embolization-a-case-report
#6
Fangfang Shi, Liwei Shen, Yonghui Shi, Lei Shi, Xiaoli Yang, Zhi Jin, Wenpeng Liu, Danhong Wu
RATIONALE: Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical and radiological features, including headache, disturbed consciousness, seizures, and cortical blindness associated with findings indicating posterior leukoencephalopathy on imaging studies. Ours is the first case of PRES developing after postpartum hemorrhage and uterine artery embolization. PATIENT CONCERNS: An 18-year-old patient had postpartum hemorrhage after a normal delivery...
December 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29218705/randomized-controlled-study-comparing-the-efficacy-of-rapid-and-slow-withdrawal-of-antiepileptic-drugs-during-long-term-video-eeg-monitoring
#7
Shambhu Kumar, Bhargavi Ramanujam, P S Chandra, Deepa Dash, Santosh Mehta, Sharma Anubha, Renjith Appukutan, Manit Kumar Rana, Manjari Tripathi
OBJECTIVE: Antiepileptic drugs (AEDs) are routinely withdrawn during long-term video-electroencephalography (EEG) monitoring (LTM), to record sufficient number of seizures. The efficacy of rapid and slow AED taper has never been compared in a randomized control trial (RCT), which was the objective of this study. METHODS: In this open-label RCT, patients aged 2-80 years with drug-resistant epilepsy (DRE) were randomly assigned (1:1) to rapid and slow AED taper groups...
December 7, 2017: Epilepsia
https://www.readbyqxmd.com/read/29203057/febrile-infection-related-epilepsy-syndrome-fires-with-super-refractory-status-epilepticus-revealing-autoimmune-encephalitis-due-to-gabaar-antibodies
#8
D Caputo, R Iorio, F Vigevano, L Fusco
BACKGROUND: Febrile infection-related epilepsy syndrome (FIRES) has been described as an epileptic encephalopathy of unknown etiology affecting previously healthy children following febrile illness. Despite large investigations on autoimmune pathogenesis no membrane antibodies has been associated since now. CASE STUDY: We report a 13 years-old girl with negative history for neurological or autoimmune disease that developed at the sixth day of high fever a super-refractory status epilepticus...
November 24, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/29111005/impact-of-non-guideline-based-treatment-of-status-epilepticus
#9
James Braun, Elizabeth Gau, Stacy Revelle, Laurie Byrne, Abhay Kumar
BACKGROUND: This retrospective study analyzed benzodiazepine usage patterns in relation to guideline recommendations for the treatment of generalized convulsive status epilepticus (GCSE) as practiced by emergency medical services (EMS) and the emergency department (ED) of an inner-city hospital. Secondary outcomes of interest were adverse events and admission/discharge outcomes. METHODS: Records of all patients≥18years old diagnosed with GCSE between June 2012 and September 2015 and transported by EMS to our hospital ED were reviewed...
November 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/29109631/comparative-evaluation-of-midazolam-dexmedetomidine-and-propofol-as-intensive-care-unit-sedatives-in-postoperative-electively-ventilated-eclamptic-patients
#10
Malik Rameez Rashid, Rukhsana Najeeb, Saima Mushtaq, Rizwana Habib
Background and Aims: Eclampsia is a common hypertensive disorder of pregnancy and treatment often includes termination of pregnancy with elective postoperative mechanical ventilation. The present study was aimed to compare midazolam, propofol, and dexmedetomidine for sedation and antihypertensive requirements of such patients admitted to Intensive Care Unit (ICU) after termination of pregnancy. Material and Methods: A total of ninety eclamptic patients administered general anesthesia for the termination of pregnancy through cesarean section and who also required postoperative ventilation were taken up for the study and were randomly allocated into three groups...
July 2017: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/29033730/intentional-intra-arterial-injection-of-midazolam-in-a-patient-with-status-epilepticus-in-the-intensive-care-unit
#11
Muhammad Asghar Ali, Muhammad Yahya
Fundamental medical care includes intravenous (IV) access which provides prompt resuscitation and reliable delivery of analgesics, antibiotics, and vasoactive medication. Difficult access populations, especially in critical area, continue to challenge providers to consider and utilize alternative means to provide IV access. Potential options under such circumstances include intramuscular, intraosseous, and intratracheal drug administration, but in extreme cases where no other options are available, intra-arterial route might be considered...
October 2017: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/28969235/super-refractory-status-epilepticus-a-therapeutic-challenge-in-paediatrics
#12
Shrikiran Aroor, Kanaparthi Shravan, Suneel C Mundkur, C Jayakrishnan, Sai Sripad Rao
A status epilepticus which persists for 24 hours or more after starting treatment with anaesthesia or has recurred inspite of general anaesthesia is known as Super-Refractory Status Epilepticus (SRSE). It includes cases where status epilepticus recurs on reduction or withdrawal of anaesthesia. SRSE, though infrequently seen, constitutes a medical emergency due to the associated high morbidity and mortality. No clear cut guidelines are available till date for the management of SRSE. Most of the published literature was case reports and expert opinion...
August 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28941387/management-protocols-for-status-epilepticus-in-the-pediatric-emergency-room-systematic-review-article
#13
REVIEW
Cheuk C Au, Ricardo G Branco, Robert C Tasker
OBJECTIVE: This systematic review of national or regional guidelines published in English aimed to better understand variance in pre-hospital and emergency department treatment of status epilepticus. SOURCES: Systematic search of national or regional guidelines (January 2000 to February 2017) contained within PubMed and Google Scholar databases, and article reference lists. The search keywords were status epilepticus, prolonged seizure, treatment, and guideline...
November 2017: Jornal de Pediatria
https://www.readbyqxmd.com/read/28886496/convulsive-status-epilepticus-in-a-quaternary-hospital-paediatric-intensive-care-unit-picu-in-south-africa-an-8-year-review
#14
Yavini Reddy, Yusentha Balakrishna, Lawrence Mubaiwa
PURPOSE: Convulsive status epilepticus (CSE) is associated with a high morbidity and mortality. This study aimed to describe the clinical profile, aetiology, neuroimaging and EEG findings as well as outcome of children with CSE in Sub-Saharan Africa. METHODS: This was a retrospective analysis of electronic records of children with CSE admitted to the Paediatric Intensive Care Unit (PICU) over an 8-year period from January 2007 to December 2014. RESULTS: Seventy six patients were admitted to the PICU with CSE and 55(72%) had refractory status epilepticus...
October 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28875555/midazolam-vs-diazepam-in-prolonged-seizures-in-children-a-pharmacoeconomic-approach
#15
E Beghi, G Capovilla, E Franzoni, F Minicucci, A Romeo, A Verrotti, F Vigevano, E Perucca
OBJECTIVE: A previous European cost-utility study reported that use of buccal midazolam in the community setting for the treatment of prolonged seizures (ie, seizures lasting ≥5 minutes) in children was associated with an overall €12 507 399 reduction in annual costs charged to the Italian national health service compared with rectal diazepam. We re-evaluated these findings by applying a more conservative approach. METHODS: The Italian Delphi panel reconvened to apply a more conservative assessment of available reports...
January 2018: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28870844/inhibitory-synapse-deficits-caused-by-familial-%C3%AE-1-gabaa-receptor-mutations-in-epilepsy
#16
Xiumin Chen, Nela Durisic, Joseph W Lynch, Angelo Keramidas
Epilepsy is a spectrum of neurological disorders with many causal factors. The GABA type-A receptor (GABAAR) is a major genetic target for heritable human epilepsies. Here we examine the functional effects of three epilepsy-causing mutations to the α1 subunit (α1(T10'I), α1(D192N) and α1(A295D)) on inhibitory postsynaptic currents (IPSCs) mediated by the major synaptic GABAAR isoform, α1β2γ2L. We employed a neuron - HEK293 cell heterosynapse preparation to record IPSCs mediated by mutant-containing GABAARs in isolation from other GABAAR isoforms...
September 1, 2017: Neurobiology of Disease
https://www.readbyqxmd.com/read/28811085/the-use-of-phenobarbital-and-other-anti-seizure-drugs-in-newborns
#17
REVIEW
Mohamed El-Dib, Janet S Soul
Neonatal seizures constitute the most frequent presenting neurologic sign encountered in the neonatal intensive care unit. Despite limited efficacy and safety data, phenobarbital continues to be used near-universally as the first-line anti-seizure drug (ASD) in neonates. The choice of second-line ASDs varies by provider and institution, and is still not supported by sufficient scientific evidence. In this review, we discuss the available evidence supporting the efficacy, mechanism of action, potential adverse effects, key pharmacokinetic characteristics such as interaction with therapeutic hypothermia, logistical issues, and rationale for use of neonatal ASDs...
October 2017: Seminars in Fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28780656/hus-induced-cardiac-and-circulatory-failure-is-reversible-using-cardiopulmonary-bypass-as-rescue
#18
René F Andersen, Jesper V Bjerre, Johan V Povlsen, Mette Veien, Konstantinos Kamperis, Søren Rittig
BACKGROUND: Extra-renal involvement in hemolytic uremic syndrome (HUS) includes gastrointestinal, pancreatic, hepatic, neurological and cardiac manifestations. The current 3-5% mortality rate in HUS patients is primarily attributed to complications related to the central nervous system and the heart. In this brief report, we illustrate that severe cardiac involvement in a patient with HUS is potentially reversible using cardiopulmonary bypass as rescue. CASE-DIAGNOSIS/TREATMENT: A 12-year-old boy was diagnosed with enterohemorrhagic Escherichia coli-induced HUS related to E...
November 2017: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
https://www.readbyqxmd.com/read/28687558/seizure-management-in-children-requiring-palliative-care-a-review-of-current-practice
#19
Nicola Harris, Megumi Baba, Charlotte Mellor, Rebekah Rogers, Kirsty Taylor, Antonia Beringer, Peta Sharples
OBJECTIVES: Controlling seizures in children approaching death can be difficult, and there is a limited evidence base to guide best practice. We compared current practice against the guidance for seizure management produced by the Association of Paediatric Palliative Medicine (APPM). METHODS: Retrospective case note review of episodes of challenging seizure management in children receiving end-of-life care over a 10-year period (2006-2015) in the south-west region of England...
July 7, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28620949/nonintravenous-rescue-medications-for-pediatric-status-epilepticus-a-cost-effectiveness-analysis
#20
Iván Sánchez Fernández, Marina Gaínza-Lein, Tobias Loddenkemper
OBJECTIVE: To quantify the cost-effectiveness of rescue medications for pediatric status epilepticus: rectal diazepam, nasal midazolam, buccal midazolam, intramuscular midazolam, and nasal lorazepam. METHODS: Decision analysis model populated with effectiveness data from the literature and cost data from publicly available market prices. The primary outcome was cost per seizure stopped ($/SS). One-way sensitivity analyses and second-order Monte Carlo simulations evaluated the robustness of the results across wide variations of the input parameters...
August 2017: Epilepsia
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