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Status epilepticus treatment

Amaia Muñoz-Lopetegi, Gorka Fernández García de Eulate, Jon Rodríguez-Antigüedad Muñoz, Alberto Bergareche, Juan José Poza
Opercular myoclonic-anarthric status epilepticus (OMASE) is a rare form of epilepsia partialis continua presenting as fluctuating dysarthria, or even anarthria. The condition is caused by an epileptogenic lesion involving the opercular cortex of either hemisphere. Speech impairment is secondary to bilateral epileptic activity affecting the glossopharyngeal muscles. This bilateral nature of the condition is due to the fact that innervation of cranial nerves V, VII, IX, X and XII from the opercular area of the primary motor cortex is bilateral...
June 15, 2018: Epileptic Disorders: International Epilepsy Journal with Videotape
Alessandra Vella, Mario Mascalchi
Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) with different radiotracers enable regional evaluation of blood flow and glucose metabolism, of receptors and transporters of several molecules, and of abnormal deposition of peptides and proteins in the brain. The cerebellum has been used as a reference region for different radiotracers in several disease conditions. Whole-brain voxel-wise analysis is not affected by a priori knowledge bias and should be preferred. SPECT and PET have contributed to establishing the cerebellum role in motion, cognition, and emotion control in physiologic and pathophysiologic conditions...
2018: Handbook of Clinical Neurology
Arjune Sen, Patricia Dugan, Piero Perucca, Daniel Costello, Hyunmi Choi, Carl Bazil, Rod Radtke, Danielle Andrade, Chantal Depondt, Sinead Heavin, Jane Adcock, W Owen Pickrell, Ronan McGinty, Fábio Nascimento, Philip Smith, Mark I Rees, Patrick Kwan, Terence J O'Brien, David Goldstein, Norman Delanty
OBJECTIVE: There is little detailed phenotypic characterization of bilateral hippocampal sclerosis (HS). We therefore conducted a multicenter review of people with pharmacoresistant epilepsy and bilateral HS to better determine their clinical characteristics. METHODS: Databases from 11 EPIGEN centers were searched. For identified cases, clinicians reviewed the medical notes, imaging, and electroencephalographic (EEG), video-EEG, and neuropsychometric data. Data were irretrievably anonymized, and a single database was populated to capture all phenotypic information...
June 14, 2018: Epilepsia
Li-Wen Chen, Chao-Ku Teng, Yi-Shan Tsai, Jieh-Neng Wang, Yi-Fang Tu, Ching-Fen Shen, Ching-Chuan Liu
INTRODUCTION: Seasonal influenza-associated neurological complications had high mortality and morbidity rates in recent studies. We reported influenza-associated encephalitis/encephalopathy in children during 2014-2017 in Taiwan, focusing on neurological presentations, neuroimaging correlations, and critical care managements. MATERIALS/SUBJECTS: During January 1st 2014 to June 30th 2017, pediatric patients reported to the Taiwan Centers for Disease Control surveillance system for severe complicated influenza infections in the hospital were retrospectively reviewed...
June 8, 2018: Brain & Development
Marina Gaínza-Lein, Iván Sánchez Fernández, Adriana Ulate-Campos, Tobias Loddenkemper, Adam P Ostendorf
OBJECTIVE: Describe basic science, animal models and clinical data related to timing of treatment in status epilepticus (SE). METHODS: We summarized the results of 15 studies that reported time to treatment in SE, and reviewed basic and clinical literature. RESULTS: SE is a life-threatening and time-sensitive emergency that requires immediate treatment. Current guidelines recommend escalation of anti-seizure medications (ASM) within specified time frames...
June 1, 2018: Seizure: the Journal of the British Epilepsy Association
Faheem Hyder Pottoo, Nahida Tabassum, Md Noushad Javed, Shah Nigar, Rouqia Rasheed, Ayash Khan, Md Abul Barkat, Md Sabir Alam, Amir Maqbool, Mohammad Azam Ansari, George E Barreto, Ghulam Md Ashraf
The present antiepileptic drugs pose several problems in the management of seizures owing to their meager neuroprotective potential, adverse effects on bone, detrimental effects on cognitive function, chronic toxicity, drug interactions, side effects including aggression, agitation, and irritability and sometimes exacerbation of seizures. We followed up progressive preclinical investigation in mice against pilocarpine (PILO)-induced status epilepticus (SE) and temporal lobe epilepsy (TLE). To determine the response of raloxifene (RF) (4 and 8 mg/kg), fluoxetine (FT) (14 and 22 mg/kg), bromocriptine (BC) (6 and 10 mg/kg), and their low-dose combinations, oral treatment was scheduled for 28 days followed by PILO (300 mg/kg, i...
June 7, 2018: Molecular Neurobiology
Martin Savard, Alain Paradis, Charles L Francoeur
New-onset refractory status epilepticus (NORSE) is a rare condition where refractory seizures occur with no obvious cause in an otherwise healthy individual. We report here the first case of a patient with NORSE caused by Jamestown Canyon virus, an emerging virus throughout North America. This is the first patient with Jamestown Canyon virus encephalitis treated by a specific antiviral agent, in this case intravenous ribavirin, with electroencephalography (EEG) evidence of improvement. This is finally the first reported death caused by this virus, here secondary to intensive care unit complications...
June 2018: Epilepsia Open
Conor S Ryan, Anthony L Fine, Alexander L Cohen, Brenda M Schiltz, Deborah L Renaud, Elaine C Wirrell, Marc C Patterson, Nicole J Boczek, Raymond Liu, Dusica Babovic-Vuksanovic, David C Chan, Eric T Payne
BACKGROUND: The dynamin 1-like gene ( DNM1L) encodes a GTPase that mediates mitochondrial and peroxisomal fission and fusion. We report a new clinical presentation associated with a DNM1L pathogenic variant and review the literature. RESULTS: A 13-year-old boy with mild developmental delays and paroxysmal dystonia presented acutely with multifocal myoclonic super-refractory status epilepticus. Despite sustained and aggressive treatment, seizures persisted and care was ultimately withdrawn in the context of extensive global cortical atrophy...
January 1, 2018: Journal of Child Neurology
Saba Jafarpour, Lawrence J Hirsch, Marina Gaínza-Lein, Christoph Kellinghaus, Kamil Detyniecki
PURPOSE: To summarize definitions, prevalence, risk factors, consequences, and acute management of seizure clusters using rescue medications. METHODS: We searched MEDLINE for studies that assessed definitions, clinical characteristics, outcomes, and use of rescue medication for aborting seizure clusters. RESULTS: Different clinical and statistical definitions for seizure clusters have been proposed, including: ≥3 seizures in 24 h, ≥2 seizures in 24 h, and ≥2 seizures in 6 h...
May 21, 2018: Seizure: the Journal of the British Epilepsy Association
József Janszky, Dalma Tényi, Beáta Bóné
According to Hungarian guidelines, valproate - with the exception of infants and small children as well as fertile women - is the first drug of choice in generalized and unclassified epilepsies because it is effective in most seizure types and epilepsy syndromes. It is highly effective in juvenile myoclonic epilepsy. Even though it is not the first-line drug in focal epilepsies, if the first-line therapy is ineffective, it is a plausible alternative as second choice therapy, owing to its different mechanism of action...
July 30, 2017: Ideggyógyászati Szemle
Eugene Lin, Victoria Calderon, Julie Goins-Whitmore, Vibhav Bansal, Osama Zaidat
Background and purpose: As the fourth mobile stroke unit (MSU) in the nation, and the first 24/7 unit worldwide, we review our initial experience with the Mercy Health MSU and institutional protocols implemented to facilitate rapid treatment of acute stroke patients and field triage for patients suffering other time-sensitive, acute neurologic emergencies in Lucas County, Ohio, and the greater Toledo metropolitan area. Methods: Data was prospectively collected for all patients transported and treated by the MSU during the first 6 months of service...
2018: Frontiers in Neurology
Batool F Kirmani, Donald Barr, Diana Mungall Robinson, Zachary Pranske, Ekokobe Fonkem, Jared Benge, Jason H Huang, Geoffrey Ling
Status epilepticus is a neurological emergency with increased morbidity and mortality. Urgent diagnosis and treatment are crucial to prevent irreversible brain damage. In this mini review, we will discuss the recent advances in the diagnosis and treatment of autoimmune status epilepticus (ASE), a rare form of the disorder encountered in the intensive care unit. ASE can be refractory to anticonvulsant therapy and the symptoms include subacute onset of short-term memory loss with rapidly progressive encephalopathy, psychiatric symptoms with unexplained new-onset seizures, imaging findings, CSF pleocytosis, and availability of antibody testing makes an earlier diagnosis of ASE possible...
2018: Frontiers in Neurology
Mehtab Alam, Mian Ayaz Ul Haq, Fawad Ali, Hina Mehwish, Kalsoom Nawab
Dyke-Davidoff-Masson Syndrome (DDMS) is a rare neurological condition characterised by drug-resistance seizures, hemiparesis, mental retardation, facial asymmetry, and intellectual disabilities. On brain imaging, the disease is characterised by cerebral hemiatrophy with ipsilateral calvarial thickening and hyperpneumotisation of paranasal sinuses or mastoid air cells. Although more common in men and on the left side of the brain, the disease can affect both genders and cerebral hemispheres. It mainly presents in childhood...
June 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Pedro David Delgado-López, Gloria Garcés-Pérez, Juan García-Carrasco, Esther Alonso-García, Ana Isabel Gómez-Menéndez, Javier Martín-Alonso
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological condition encountered in many different clinical settings, generally occurring in the context of hypertensive crisis, immunosuppressive therapy or autoimmune diseases. It is characterized by headache, stupor, seizures and visual alterations. MRI findings include white matter changes preferentially in the parieto-occipital regions. Although pathogenesis is not fully elucidated, vasoconstriction and brain hypoperfusion seem to be the cause of brain ischemia and vasogenic edema...
June 1, 2018: World Neurosurgery
Pedro Vicente Ferreira Naves, Marcelo Calderaro, Luis Otavio Caboclo
Myoclonic status epilepticus (MSE) in patients without epilepsy, or de novo MSE, is a rare condition associated with several acute symptomatic etiologies, including drugs and toxins. We describe a 94-year-old woman with Alzheimer dementia and long use of mirtazapine 30 mg/d and alprazolam 1 mg/d who developed MSE approximately 24 hours after abrupt discontinuation of alprazolam. The patient was taking sulfamethoxazole/trimethoprim for urinary tract infection, diagnosed 2 weeks before admission. She had no history of seizures...
May 30, 2018: Clinical Neuropharmacology
Jacob A Lebin, Joshua D Villarreal, Betty C Chen, M Kennedy Hall
Clozapine is an atypical antipsychotic drug prescribed for treatment-resistant schizophrenia. The risk of adverse hematologic, cardiovascular, and neurologic effects has tempered its use, and reports of overdoses remain rare. We report a case of accidental acute clozapine intoxication in a clozapine-naïve patient, who presented with symptoms mimicking acute stroke and later developed status epilepticus. Clozapine intoxication is a rare presentation in the emergency department with potential for iatrogenic harm if not correctly identified...
May 2018: Clinical practice and cases in emergency medicine
Lothar Burghaus, Christian Dohmen, Michael Malter
Status epilepticus is a neurologic emergency manifested by prolonged seizure activity or multiple seizures without full recovery of previous condition in between. The most important aim of treatment is early seizure termination, because duration of status epilepticus correlates with a higher rate of morbidity and mortality. Based on evidence from clinical trials and guidelines strategies for management of status epilepticus are provided.
May 2018: Fortschritte der Neurologie-Psychiatrie
Johan Bjellvi, Niklas Timby, Roland Flink
Status epilepticus, a condition with prolonged or repeated seizures, is a common neurological emergency with significant morbidity and mortality. This text outlines the treatment and initial work-up for convulsive and non-convulsive status epilepticus in adults and children. The most serious form is convulsive (tonic-clonic) status epilepticus, which requires rapid treatment and work-up. Bensodiazepines are the preferred initial treatment, while antiepileptic drugs and anesthetics are added if seizures continue...
May 22, 2018: Läkartidningen
Magali Chartier, Isabelle Malissin, Salma Tannous, Laurence Labat, Patricia Risède, Bruno Mégarbane, Lucie Chevillard
Baclofen, a γ-amino-butyric acid type-B receptor agonist with exponentially increased use at high-dose to facilitate abstinence in chronic alcoholics, is responsible for increasing poisonings. Baclofen overdose may induce severe encephalopathy and electroencephalographic (EEG) abnormalities. Whether prior prolonged baclofen treatment may influence the severity of baclofen-induced encephalopathy in overdose has not been established. We designed a rat study to characterize baclofen-induced encephalopathy, correlate its severity with plasma concentrations and investigate the contribution of tolerance...
May 18, 2018: Progress in Neuro-psychopharmacology & Biological Psychiatry
Kathleen M Gorman, Heather Cary, Laura Gaffney, Eva Forman, Dympna Waldron, Fowzy Al-Delami, Bryan J Lynch, Mary D King, Nicholas M Allen
Movement disorders are increasingly identified in infantile encephalopathies due to single gene disorders (e.g. SCN2A, CDKL5, ARX). The associated movement disorder can be challenging to recognise and treat. We report a 2 year-old boy with a background history of Ohtahara syndrome due to a missense variant in ARX (the aristaless-related homeobox gene) who subsequently developed status dystonicus. ARX is a transcription factor that plays a critical role in cortical neuronal development and is associated with a range of important neurodevelopmental disorders depending on the site of the pathogenic variant...
May 3, 2018: European Journal of Paediatric Neurology: EJPN
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