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Super-refractory seizure

Giuseppe d'Orsi, Maria Grazia Pascarella, Tommaso Martino, Elena Carapelle, Francesca Pacillo, Maria Teresa Di Claudio, Daniela Mancini, Marina Trivisano, Carlo Avolio, Luigi M Specchio
PURPOSE: to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients. METHODS: we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200-400mg and the maintenance dose was 200-400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion...
September 22, 2016: Seizure: the Journal of the British Epilepsy Association
Jamil M Beg, Thomas D Anderson, Kevin Francis, Lisa M Meckley, David Fitzhenry, Todd Foster, Susheel Sukhtankar, Stephen J Kanes, Lidia M V R Moura
OBJECTIVE: To provide an estimate of the annual number of super-refractory status epilepticus (SRSE) cases in the US and to evaluate utilization of hospital resources by these patients. METHODS: The Premier Hospital Database was utilized to estimate the number of SRSE cases based on hospital discharges during 2012. Discharges were classified as SRSE cases based on an algorithm using seizure-related International Classification of Diseases-9 (ICD-9) codes, Intensive Care Unit (ICU) length of stay (LOS), and treatment protocols (e...
August 11, 2016: Journal of Medical Economics
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
Sara Hocker, Elanagan Nagarajan, Alejandro A Rabinstein, Dennis Hanson, Jeffrey W Britton
Importance: Prolonged seizures in super-refractory status epilepticus (SRSE) have been shown to cause neuronal death and reorganization, and visual inspection in individual case studies has demonstrated progressive cortical and subcortical atrophy. At present, magnetic resonance imaging (MRI) studies that evaluate brain atrophy in SRSE are lacking. Objectives: To document and quantify the development of atrophy over time in SRSE. Design, Setting, and Participants: This retrospective medical record review included all patients with SRSE who were admitted to a tertiary referral campus of the Mayo Clinic Hospital with SRSE from January 1, 2001, to December 31, 2013...
October 1, 2016: JAMA Neurology
Brian Appavu, Natalie Guido-Estrada, Kristin Lindstrom, Theresa Grebe, John F Kerrigan, Matthew Troester
TBC1D24 is a newly recognized gene in which variations lead to variable clinical phenotypes including drug-resistant epilepsy. We report four patients with novel variants of TBC1D24 demonstrating drug-resistant focal epilepsy, developmental delays, and head growth deceleration. All patients had seizure semiologies consisting of prolonged, unilateral, focal clonic activity of the arm, leg or face, in addition to generalized clonic or myoclonic seizures. Ictal EEG characteristics included epilepsia partialis continua, epilepsy of infancy with migrating focal seizures, and other focal seizures with indiscrete interictal-ictal transitions...
September 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Julia Höfler, Alexandra Rohracher, Gudrun Kalss, Georg Zimmermann, Judith Dobesberger, Georg Pilz, Markus Leitinger, Giorgi Kuchukhidze, Kevin Butz, Alexandra Taylor, Helmut Novak, Eugen Trinka
OBJECTIVE: The aim was to describe the safety and efficacy of (S)-ketamine [(S)-KET] in a series of patients with refractory and super-refractory status epilepticus (RSE and SRSE) in a specialized neurological intensive care unit (NICU). METHODS: We retrospectively analyzed the data of patients with RSE and SRSE treated with (S)-KET in the NICU, Salzburg, Austria, from 2011 to 2015. Data collection included demographic features, clinical presentation, diagnosis, electroencephalogram (EEG) data, anticonvulsant treatment, timing, and duration of treatment with (S)-KET...
September 2016: CNS Drugs
Devashish Dhiren Vyas, Gopal Krishna Dash
A 28-year old female was admitted with recurrent seizures following 2 days of febrile illness, after which she developed status epilepticus. Midazolam and later thiopentone infusions were started after failure of regular intravenous antiepileptics. Burst suppression was achieved at doses of 3 mg/kg/hr for midazolam and 6 mg/kg/hr of thiopentone. Adjunctive medications included methylprednisolone, intravenous immunoglobulin and acyclovir. Imaging and biochemical parameters were normal. She required 3 cycles of midazolam and 2 cycles of thiopentone for complete cessation of seizures...
June 2016: Journal of Epilepsy Research
Sandeep B Patil, Arun Grace Roy, Kollencheri Puthenveettil Vinayan
PURPOSE: To describe the clinical features and outcome of febrile infection-related epilepsy syndrome (FIRES), a catastrophic epileptic encephalopathy, in a cohort of South Indian children. MATERIALS AND METHODS: We performed a retrospective chart review of a cohort of children with previously normal development who presented with status epilepticus or encephalopathy with recurrent seizures following a nonspecific febrile illness during the period between January 2007 and January 2012...
April 2016: Annals of Indian Academy of Neurology
Carmen Paz Vargas L, Ximena Varela E, Karin Kleinsteuber S, Rocío Cortés Z, María de Los Ángeles Avaria B
Pediatric Status Epilepticus (SE) is an emergency situation with high morbidity and mortality that requires early and aggressive management. The minimum time criterion to define SE was reduced from 30 to 5 minutes, defined as continuous seizure activity or rapidly recurrent seizures without resumption of consciousness for more than 5 minutes. This definition considers that seizures that persist for > 5 minutes are likely to do so for more than 30 min. Those that persist for more than 30 minutes are more difficult to treat...
January 2016: Revista Médica de Chile
M A de la Morena Vicente, J J Granizo Martínez, J Ojeda Ruiz de Luna, A Peláez Hidalgo, M Luque Alarcón, F J Navacerrada Barrero, S Al Hussayni Husseini, E García Cobos, L Ballesteros Plaza, G de Las Casas Cámara, I Viudez Jiménez
INTRODUCTION: Status epilepticus (SE) is a neurological emergency associated with significant mortality and morbidity. We analyse characteristics of this entity in our population. METHODS: Data from electronic medical records of adults diagnosed with SE were collected retrospectively from 5 hospitals over 4 years. RESULTS: Data reflected 84 episodes of SE in 77 patients with a mean age of 60.3 years. Of this sample, 52.4% had a previous history of epilepsy...
February 10, 2016: Neurología: Publicación Oficial de la Sociedad Española de Neurología
Vincent Alvarez, Frank W Drislane
When status epilepticus (SE) remains refractory to appropriate therapy, it is associated with high mortality and with substantial morbidity in survivors. Many outcome predictors such as age, seizure type, level of consciousness before treatment, and mostly, etiology, are well-established. A longer duration of SE is often associated with worse outcome, but duration may lose its prognostic value after several hours. Several terms and definitions have been used to describe prolonged, refractory SE, including "malignant SE," "prolonged" SE, and more recently, "super refractory" SE, defined as "SE that has continued or recurred despite 24 hours of general anesthesia (or coma-inducing anticonvulsants)...
February 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Eugen Trinka, Julia Höfler, Markus Leitinger, Alexandra Rohracher, Gudrun Kalss, Francesco Brigo
INTRODUCTION: Status epilepticus (SE) requires rapid identification of its cause and urgent pharmacological treatment. Despite an estimated incidence of up to 61 per 100,000 per year, evidence from high-class clinical trials is only available for the early stages of SE. AREAS COVERED: Following a four-stage approach of SE (early, established, refractory and super-refractory), we present pharmacological treatment options and their clinical utility. EXPERT OPINION: Intravenous lorazepam and intramuscular midazolam appear as most effective treatments for early SE...
2016: Expert Opinion on Pharmacotherapy
Jung-Ick Byun, Kon Chu, Jun-Sang Sunwoo, Jangsup Moon, Tae-Joon Kim, Jung-Ah Lim, Jin-Sun Jun, Han Sang Lee, Woo-Jin Lee, Doo Young Lee, Daejong Jeon, Soon-Tae Lee, Keun-Hwa Jung, Ki-Young Jung, Sang Kun Lee
AIMS: To evaluate the efficacy and safety of mega-dose phenobarbital (MDPB; enteral or parenteral phenobarbital >10 mg/kg/day) for treating super-refractory status epilepticus (SRSE; continuous or recurrent status epilepticus for ≥24 hours after the onset of continuous anaesthetic treatment) in adult patients. METHODS: Adult patients with SRSE who were treated with MDPB in our institution from March 2005 to September 2014 were reviewed. We collected data on basic demographics, clinical features, functional status, anticonvulsant treatment, and possible adverse events...
December 2015: Epileptic Disorders: International Epilepsy Journal with Videotape
Carolina Cuello Oderiz, Marina Aberastury, Ana Gabriela Besocke, Jorge Sinner, Betiana Comas-Guerrero, Carlos Alberto Ciraolo, Maria Concepción Pasteris, Walter Horacio Silva, María Del Carmen García
PURPOSE: Neurosurgery appears to be a reasonable alternative in carefully selected patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). We discuss the optimal timing of the surgery and the use of previous stereoelectroencephalography (SEEG) invasive evaluation. METHODS: We identified 3 patients (two pediatric and one adult) who underwent epilepsy surgery because of RSE or SRSE from our epilepsy surgery database, one of them with previous SEEG...
2015: Epilepsy & Behavior Case Reports
Mauricio Ruiz Cuero, Panayiotis N Varelas
Although the vast majority of patients with status epilepticus (SE) respond fairly well to the first- or second-line anti-epileptics, a minority require anesthetic agents to put the seizures under control. An even smaller number of patients do not even respond to those and constitute the subgroup of super-refractory SE. Because of the small numbers, there are no definitive studies regarding its etiology, pathophysiology, and treatment, and those are still based on expert opinions. Encephalitides, either infectious, autoimmune, or paraneoplastic may be the main etiological factors...
November 2015: Current Neurology and Neuroscience Reports
Giada Giovannini, Giulia Monti, Michela M Polisi, Laura Mirandola, Andrea Marudi, Giovanni Pinelli, Franco Valzania, Massimo Girardis, Paolo F Nichelli, Stefano Meletti
Refractory status epilepticus (RSE) is a particular critical condition characterized by seizures that continue despite the use of first- and second-line therapies and by high mortality. To date, only one prospective study investigated clinical features and prognostic factors in RSE. In this study, we performed a one-year prospective survey to identify clinical features, outcomes, and variables associated with the development of RSE in the adolescent and adult population of Modena, northern Italy. We observed 83 episodes of SE in 83 patients...
August 2015: Epilepsy & Behavior: E&B
Gentle Sunder Shrestha, Pankaj Joshi, Santosh Chhetri, Ragesh Karn, Subhash Prasad Acharya
Refractory and super-refractory status epilepticus is a life-threatening neurological emergency, associated with high morbidity and mortality. Treatment should be aimed to stop seizure and to avoid cerebral damage and another morbidity. Published data about effectiveness, safety and outcome of various therapies and treatment approaches are sparse and are mainly based on small case series and retrospective data. Here we report successful management of two cases of super-refractory status epilepticus refractory to anesthetic therapy with midazolam and complicated by septic shock, managed successfully with ketamine infusion...
May 2015: Indian Journal of Critical Care Medicine
A Rohracher, J Höfler, G Kalss, M Leitinger, G Kuchukhidze, I Deak, J Dobesberger, H Novak, G Pilz, A Zerbs, E Trinka
INTRODUCTION: In refractory status epilepticus (SE), because of subcellular maladaptive changes, GABAergic drugs are no longer effective, and the excitatory neurotransmitter glutamate (Glu) plays a major role in seizure perpetuation. Perampanel (PER, licensed since 09/2012) is the first orally active noncompetitive AMPA receptor antagonist for adjunctive treatment of refractory focal epilepsy. METHODS: We analyzed treatment response, seizure outcome, and adverse effects of add-on treatment with perampanel in patients with refractory status epilepticus in the Neurological Intensive Care Unit (NICU), Salzburg, Austria between 09/2012 and 11/2014 by retrospective chart review...
August 2015: Epilepsy & Behavior: E&B
M Ferlisi, S Hocker, M Grade, E Trinka, S Shorvon
The treatment of refractory and super refractory status epilepticus is a "terra incognita" from the point of view of evidence-based medicine. As randomized or controlled studies that are sufficiently powered are not feasible in relation to the many therapies and treatment approaches available, we carried out an online multinational audit (registry) in which neurologists or intensivists caring for patients with status epilepticus may prospectively enter patients who required general anesthesia to control the status epilepticus (SE)...
August 2015: Epilepsy & Behavior: E&B
Esther E Moreno-Medinilla, Rocío Negrillo-Ruano, Rocío Calvo-Medina, M Dolores Mora-Ramírez, Jacinto L Martínez-Antón
INTRODUCTION: Status epilepticus (SE) is the most common neurological emergency on pediatric. Given the possibility of neurological sequelae and mortality associated, it requires an early aggressive treatment. PATIENTS AND METHODS: Retrospective descriptive study based on the review of medical histories of patients admitted to our hospital from 2010 to 2013 with a diagnosis of SE. The objective was to describe the epidemiology characteristics and the management of these patients, and to review the available literature on this topic...
May 1, 2015: Revista de Neurologia
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