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Super-refractory seizure

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https://www.readbyqxmd.com/read/28282553/challenges-in-the-treatment-of-convulsive-status-epilepticus
#1
REVIEW
Gaetano Zaccara, Gianfranco Giannasi, Roberto Oggioni, Eleonora Rosati, Luciana Tramacere, Pasquale Palumbo
Convulsive status epilepticus (CSE) is a medical emergency associated with high mortality and morbidity. The most recent definition of CSE is a convulsive seizure lasting more than 5min or consecutive seizures without recovery of consciousness. In adults, for the treatment of the early stages of CSE, diazepam, lorazepam or midazolam are the most common treatments, although the choice of agent seems less important than rapid treatment. Midazolam, when administered intramuscularly (best evidence), buccally, or nasally, is effective and safe in the pre-hospital setting...
February 28, 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/28281491/status-epilepticus-refractory-and-super-refractory
#2
REVIEW
Deepanshu Dubey, Jayantee Kalita, Usha K Misra
Status epilepticus (SE) is an important neurological emergency. It is defined as seizures lasting for 5 minutes or more or recurrent seizures without recovery of consciousness to baseline between the attacks. Refractory SE (RSE) is defined as SE persisting despite sufficient dose of benzodiazepines and at least one antiepileptic drug (AED), irrespective of time. Super refractory SE (SRSE) is defined as SE that continues for 24 hours or more after the use of anesthetic therapy, including cases that recur on weaning of the anesthestic agent...
2017: Neurology India
https://www.readbyqxmd.com/read/28182114/evolution-of-cerebral-atrophy-in-a-patient-with-super-refractory-status-epilepticus-treated-with-barbiturate-coma
#3
Christopher R Newey, Pravin George, Premkumar Nattanmai, Christine Ahrens, Stephen Hantus, Aarti Sarwal
Introduction. Status epilepticus is associated with neuronal breakdown. Radiological sequelae of status epilepticus include diffusion weighted abnormalities and T2/FLAIR cortical hyperintensities corresponding to the epileptogenic cortex. However, progressive generalized cerebral atrophy from status epilepticus is underrecognized and may be related to neuronal death. We present here a case of diffuse cerebral atrophy that developed during the course of super refractory status epilepticus management despite prolonged barbiturate coma...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28057897/review-and-update-of-the-hong-kong-epilepsy-guideline-on-status-epilepticus
#4
REVIEW
E Lw Fung, B Bh Fung
Convulsive status epilepticus is the most extreme form of seizure. It is a medical and neurological emergency that requires prompt and appropriate treatment. Treatment of convulsive status epilepticus is usually divided into stages/steps. The International League Against Epilepsy has released a new definition of status epilepticus that may help to unify the definition in future studies. Over the last few years new information has become available regarding its management. The Rapid Anticonvulsant Medication Prior to Arrival Trial demonstrated non-inferiority of intramuscular midazolam in early status epilepticus compared with intravenous lorazepam...
January 6, 2017: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
https://www.readbyqxmd.com/read/28028789/isoflurane-use-in-the-treatment-of-super-refractory-status-epilepticus-is-associated-with-hippocampal-changes-on-mri
#5
Kristin M Ikeda, Robert Connors, Donald H Lee, Alexander G Khandji, Jan Claassen, G Bryan Young
BACKGROUND: Refractory status epilepticus (RSE) is associated with high morbidity and mortality. Experts recommend aggressive management with continuous intravenous infusions or inhaled anesthetics such as isoflurane. However, there is concern that MRI changes in RSE reflect isoflurane neurotoxicity. We performed a case-control study to determine whether isoflurane is neurotoxic, based on MRI signal changes. METHODS: We performed a retrospective case-control study of the incidence of MRI changes in RSE treated with and without isoflurane...
December 27, 2016: Neurocritical Care
https://www.readbyqxmd.com/read/28004305/topiramate-in-the-treatment-of-generalized-convulsive-status-epilepticus-in-adults-a-systematic-review-with-individual-patient-data-analysis
#6
REVIEW
Francesco Brigo, Nicola Luigi Bragazzi, Stanley C Igwe, Raffaele Nardone, Eugen Trinka
BACKGROUND: Generalized convulsive status epilepticus (GCSE) is a medical emergency associated with high morbidity and mortality that requires prompt medical intervention. Topiramate (TPM) is an antiepileptic drug effective against a broad spectrum of seizure types, and has been proposed as a possible therapeutic option for super-refractory status epilepticus (SRSE), the most severe form of GCSE. AIM: This review aimed to evaluate the role of TPM in GCSE, including SRSE...
January 2017: Drugs
https://www.readbyqxmd.com/read/27890484/25-years-of-advances-in-the-definition-classification-and-treatment-of-status-epilepticus
#7
REVIEW
Eugen Trinka, Reetta Kälviäinen
PURPOSE: Status epilepticus (SE) requires not only urgent symptomatic treatment with antiepileptic drugs but also rapid identification and treatment of its cause. This narrative review summarizes the most important advances in classification and treatment of SE. METHOD: Data sources included MEDLINE, EMBASE, ClinicalTrials.gov, and back tracking of references in pertinent studies, reviews, and books. RESULTS: SE is now defined as "a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1)...
January 2017: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/27843471/brain-on-fires-super-refractory-seizure-in-a-7-yr-old-boy
#8
Alireza Tavasoli, Behdad Gharib, Houman Alizadeh, Hossein Farshadmoghaddam, Sara Memarian, Mahmoodreza Ashrafi, Meisam Sharifzade
We present a 7 yr old boy afflicted with super-refractory seizure that responded poorly to antiepileptic drugs and sustained a long course of hospitalization and complications of high doses of medications as well as longstanding stay in hospital. The differential diagnoses were, fever-induced refractory epileptic encephalopathy (FIRES), and infectious and autoimmune encephalitis. However, work-ups had not revealed any evidence of any specific diagnosis, so we assumed that he was afflicted by viral infectious encephalitis as he had, fever, vomiting, and prodromal symptoms of infectious (most probably viral) disease prior to onset of the seizure attacks...
2016: Iranian Journal of Child Neurology
https://www.readbyqxmd.com/read/27829714/seizures-just-the-tip-of-the-iceberg-critical-care-management-of-super-refractory-status-epilepticus
#9
REVIEW
Karen Ruby Lionel, Ajay Prasad Hrishi
Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 h or more after the onset of anesthetic therapy, including those cases where SE recurs on the reduction or withdrawal of anesthesia. Although SRSE is a rare clinical problem, it is associated with high mortality and morbidity rates. This article reviews the treatment approaches and the systemic complications commonly encountered in patients with SRSE. As evident in our search of literature, therapy for SRSE and its complications have been based on clinical reports and expert opinions since there is a lack of controlled and randomized trials...
October 2016: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/27693808/intravenous-lacosamide-in-seizure-emergencies-observations-from-a-hospitalized-in-patient-adult-population
#10
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...
November 2016: Seizure: the Journal of the British Epilepsy Association
https://www.readbyqxmd.com/read/27556834/burden-of-illness-for-super-refractory-status-epilepticus-patients
#11
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...
January 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/27553113/a-practical-approach-to-ketogenic-diet-in-the-pediatric-intensive-care-unit-for-super-refractory-status-epilepticus
#12
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
https://www.readbyqxmd.com/read/27533350/progressive-brain-atrophy-in-super-refractory-status-epilepticus
#13
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
https://www.readbyqxmd.com/read/27502353/electroclinical-phenotypes-and-outcomes-in-tbc1d24-related-epilepsy
#14
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
https://www.readbyqxmd.com/read/27465262/-s-ketamine-in-refractory-and-super-refractory-status-epilepticus-a-retrospective-study
#15
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
https://www.readbyqxmd.com/read/27390680/supra-recommendation-treatment-of-super-refractory-status-epilepticus
#16
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
https://www.readbyqxmd.com/read/27293328/clinical-profile-and-treatment-outcome-of-febrile-infection-related-epilepsy-syndrome-in-south-indian-children
#17
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
https://www.readbyqxmd.com/read/26998986/-management-of-pediatric-status-epilepticus
#18
REVIEW
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
https://www.readbyqxmd.com/read/26874570/retrospective-multicentre-observational-study-on-clinical-management-and-treatment-of-different-types-of-status-epilepticus-in-clinical-practice
#19
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
https://www.readbyqxmd.com/read/26840875/is-favorable-outcome-possible-after-prolonged-refractory-status-epilepticus
#20
REVIEW
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
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