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Status epilepticus protocol

Lisa Gillinder, Alexander Lehn, Helen Brown, Sasha Dionisio
OBJECTIVE: The present study aims to determine qualitative outcomes of presentations with acute recurrent seizures or status epilepticus to the emergency department of our institution after the introduction of a new seizure management protocol METHODS: We performed a retrospective analysis on two cohorts of patients for all presentation to the emergency department of our institution. Presentations were reviewed from January to July pre protocol introduction and the same period post protocol...
February 20, 2018: Internal Medicine Journal
Sunit Singhi, Suresh Kumar Angurana
CNS infections in children are medical emergency and are associated with high mortality and morbidity. For diagnosis, a high index of suspicion is required. Clinical assessment should be supplemented by laboratory investigations including CSF Gram stain and cultures, blood culture, PCR on CSF, serological tests, and imaging. Commonly associated life threatening complications include coma, seizure, raised intracranial pressure (ICP), focal deficits, shock, respiratory failure, and fluid and electrolyte abnormalities...
January 15, 2018: Indian Journal of Pediatrics
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
Leena Kämppi, Harri Mustonen, Kaisa Kotisaari, Seppo Soinila
PURPOSE: This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. METHOD: This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge...
December 28, 2017: Seizure: the Journal of the British Epilepsy Association
Anne-Marie Neumann, Julia Abele, Timo Kirschstein, Robby Engelmann, Tina Sellmann, Rüdiger Köhling, Brigitte Müller-Hilke
Growing clinical and laboratory evidence corroborates a role for the immune system in the pathophysiology of epilepsy. In order to delineate the immune response following pilocarpine-induced status epilepticus (SE) in the mouse, we monitored the kinetics of leukocyte presence in the hippocampus over the period of four weeks. SE was induced following a ramping protocol of pilocarpine injection into 4-5 weeks old C57BL/6 mice. Brains were removed at days 1-4, 14 or 28 after SE, and the hippocampi were analyzed via flow cytometry, via quantitative reverse transcriptase PCR (qRT-PCR) and via immunohistochemistry...
2017: PloS One
Emily Peien Fan, Gabriel Heiber, Elizabeth E Gerard, Stephan Schuele
OBJECTIVE: To understand the frequency of electrographic and clinical seizures in patients with stroke-like migraine attacks after radiation therapy (SMART), and determine whether SMART warrants comprehensive electroencephalographic (EEG) monitoring and aggressive seizure management. METHODS: We searched our magnetic resonance brain imaging report database for all patients between January 2013 and December 2015 for suspected SMART syndrome. Clinical inclusion criteria were further applied as follows: inpatient adults (>18 years of age) with history of cranial radiation presenting with acute neurologic deficits as primary admission reason who lacked evidence of recurrent or new brain malignancy, stroke, or infectious agents in cerebrospinal fluid...
January 2018: Epilepsia
Daniele Bertoglio, Halima Amhaoul, Annemie Van Eetveldt, Ruben Houbrechts, Sebastiaan Van De Vijver, Idrish Ali, Stefanie Dedeurwaerdere
The aim of epilepsy models is to investigate disease ontogenesis and therapeutic interventions in a consistent and prospective manner. The kainic acid-induced status epilepticus (KASE) rat model is a widely used, well-validated model for temporal lobe epilepsy (TLE). As we noted significant variability within the model between labs potentially related to the rat strain used, we aimed to describe two variants of this model with diverging seizure phenotype and neuropathology. In addition, we evaluated two different protocols to induce status epilepticus (SE)...
2017: Frontiers in Neurology
Murat Mert Atmaca, Candan Gurses
PURPOSE: To search the literature for the frequency, pathogenesis, prognosis, and treatment of seizures and status epilepticus (SE) in patients with multiple sclerosis (MS). METHODS: We report 2 patients with MS who presented with SE and review the literature. RESULTS: Seizures and SE episodes worsened during MS relapses in the first patient. SE episodes and MS relapses significantly decreased after initiation of natalizumab treatment but she still had seizures and was taking 4 antiepileptic drugs (AEDs)...
January 1, 2017: Clinical EEG and Neuroscience: Official Journal of the EEG and Clinical Neuroscience Society (ENCS)
Ezekiel Carpenter-Hyland, Edyta K Bichler, Mathew Smith, Robert S Sloviter, Morris Benveniste
Hippocampal neuron plasticity is strongly associated with learning, memory, and cognition. In addition to modification of synaptic function and connectivity, the capacity of hippocampal neurons to undergo plasticity involves the ability to change nonsynaptic excitability. This includes altering the probability that EPSPs will generate action potentials (E-S plasticity). Epilepsy is a prevalent neurological disorder commonly associated with neuronal hyperexcitability and cognitive dysfunction. We examined E-S plasticity in chronically epileptic Sprague-Dawley rats 3-10 weeks after pilocarpine-induced status epilepticus CA1 neurons in hippocampal slices were assayed by whole-cell current clamp to measure EPSPs evoked by Schaffer collateral stimulation...
November 2017: Physiological Reports
Lauren E Payne, David J Gagnon, Richard R Riker, David B Seder, Elizabeth K Glisic, Jane G Morris, Gilles L Fraser
BACKGROUND: Cefepime is a widely used antibiotic with neurotoxicity attributed to its ability to cross the blood-brain barrier and exhibit concentration-dependent ϒ-aminobutyric acid (GABA) antagonism. Neurotoxic symptoms include depressed consciousness, encephalopathy, aphasia, myoclonus, seizures, and coma. Data suggest that up to 15% of ICU patients treated with cefepime may experience these adverse effects. Risk factors include renal dysfunction, excessive dosing, preexisting brain injury, and elevated serum cefepime concentrations...
November 14, 2017: Critical Care: the Official Journal of the Critical Care Forum
Tatjana Zekić, Mirjana Stanić Benić, Ronald Antulov, Igor Antončić, Srđan Novak
The cyclophosphamide as a predisposing factor for Posterior Reversible Encephalopathy Syndrome (PRES) and therapeutic option for systemic lupus erythematosus (SLE) is still confusing. The first and only case of PRES, probably induced by cyclophosphamide, in Croatia followed by the findings of 36 SLE patients diagnosed with PRES after treatment with cyclophosphamide worldwide are described. An 18-year-old Caucasian female patient with a 1-year history of SLE was admitted to the hospital due to lupus nephritis and acute arthritis...
December 2017: Rheumatology International
Alessio Baricich, A de Sire, E Antoniono, F Gozzerino, G Lamberti, C Cisari, M Invernizzi
Patients who have suffered severe traumatic or nontraumatic brain injuries can show a progressive recovery, transitioning through a range of clinical conditions. They may progress from coma to a vegetative state (VS) and/or a minimally conscious state (MCS). A longer duration of the VS is known to be related to a lower probability of emergence from it; furthermore, the literature seems to lack evidence of late improvements in these patients. This real-practice prospective cohort study was conducted in inpatients in a VS following a severe brain injury, consecutively admitted to a vegetative state unit (VSU)...
July 2017: Functional Neurology
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
Robert D Nass, Sina Meiling, René P Andrié, Christian E Elger, Rainer Surges
BACKGROUND: Generalized tonic-clonic seizures (GTCS) frequently lead to emergency inpatient referrals. Laboratory blood values are routinely performed on admission to detect underlying causes and metabolic or cardiac complications. Our goal was to assess the nature and frequency of complications occurring in association with GTCS. METHODS: We retrospectively extracted data from emergency protocols and discharge letters of adult patients admitted to the Department of Epileptology between 01/2010 and 06/2015...
September 19, 2017: BMC Neurology
Jan Claassen, Joshua N Goldstein
Patients with prolonged or rapidly recurring convulsions lasting more than 5 min should be considered to be in status epilepticus (SE) and receive immediate resuscitation. Although there are few randomized clinical trials, available evidence and experience suggest that early and aggressive treatment of SE improves patient outcomes, for which reason this was chosen as an Emergency Neurological Life Support protocol. The current approach to the emergency treatment of SE emphasizes rapid initiation of adequate doses of first line therapy, as well as accelerated second line anticonvulsant drugs and induced coma when these fail, coupled with admission to a unit capable of neurological critical care and electroencephalography monitoring...
September 2017: Neurocritical Care
Yajie Chi, Bolin Wu, Jianwei Guan, Kuntai Xiao, Ziming Lu, Xiao Li, Yuting Xu, Shan Xue, Qiang Xu, Junhua Rao, Yanwu Guo
OBJECTIVE: Temporal lobe epilepsy (TLE) is a common type of acquired epilepsy refractory to medical treatment. As such, establishing animal models of this disease is critical to developing new and effective treatment modalities. Because of their small head size, rodents are not suitable for comprehensive electroencephalography (EEG) evaluation via scalp or subdural electrodes. Therefore, a larger primate model that closely recapitulates signs of TLE is needed; here we describe a rhesus monkey model resembling chronic TLE...
September 6, 2017: Brain Research Bulletin
Roberto Caraballo, Francesca Darra, Gabriela Reyes, Marisa Armeno, Araceli Cresta, Graciela Mestre, Bernardo Dalla Bernardina
Myoclonic status in non-progressive encephalopathy (MSNPE) is characterized by the recurrence of long-lasting atypical status epilepticus associated with attention impairment and continuous polymorphous jerks, mixed with other complex abnormal movements, in infants suffering from a non-progressive encephalopathy. The ketogenic diet (KD) has been used as an alternative to antiepileptic drugs (AEDs) for patients with refractory epileptic encephalopathies. PURPOSE: In this study we assess the efficacy and tolerability of the KD in patients with MSNPE...
October 2017: Seizure: the Journal of the British Epilepsy Association
Stuart R Dalziel, Jeremy Furyk, Megan Bonisch, Ed Oakley, Meredith Borland, Jocelyn Neutze, Susan Donath, Cynthia Sharpe, Simon Harvey, Andrew Davidson, Simon Craig, Natalie Phillips, Shane George, Arjun Rao, Nicholas Cheng, Michael Zhang, Kam Sinn, Amit Kochar, Christine Brabyn, Franz E Babl
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening childhood neurological emergency. Despite this, there is a lack of high quality evidence supporting medication use after first line benzodiazepines, with current treatment protocols based solely on non-experimental evidence and expert opinion. The current standard of care, phenytoin, is only 60% effective, and associated with considerable adverse effects. A newer anti-convulsant, levetiracetam, can be given faster, is potentially more efficacious, with a more tolerable side effect profile...
June 22, 2017: BMC Pediatrics
Mark D Lyttle, Carrol Gamble, Shrouk Messahel, Helen Hickey, Anand Iyer, Kerry Woolfall, Amy Humphreys, Naomi E A Bacon, Louise Roper, Franz E Babl, Stuart R Dalziel, Mary Ryan, Richard E Appleton
BACKGROUND: Convulsive status epilepticus (CSE) is the most common life-threatening neurological emergency in childhood. These children are also at risk of significant morbidity, with acute and chronic impact on the family and the health and social care systems. The current recommended first-choice, second-line treatment in children aged 6 months and above is intravenous phenytoin (fosphenytoin in the USA), although there is a lack of evidence for its use and it is associated with significant side effects...
June 19, 2017: Trials
Jeremy Furyk, Kerriane Watt, Theophilus I Emeto, Stuart Dalziel, Daniel Bodnar, Kate Riney, Franz E Babl
Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand...
August 2017: Emergency Medicine Australasia: EMA
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