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Status epilepticus protocol

Luciana Rodrigues De Marchi, Jeana Torres Corso, Ana Carolina Zetehaku, Carina Gonçalves Pedroso Uchida, Mirian Salvadori Bittar Guaranha, Elza Márcia Targas Yacubian
INTRODUCTION: Video-EEG has been used to characterize genetic generalized epilepsies (GGE). For best performance, sleep recording, photic stimulation, hyperventilation, and neuropsychological protocols are added to the monitoring. However, risks and benefits of these video-EEG protocols are not well established. The aim of this study was to analyze the efficacy and safety of a video-EEG neuropsychological protocol (VNPP) tailored for GGE and compare its value with that of routine EEG (R-EEG)...
April 18, 2017: Epilepsy & Behavior: E&B
Pascal Bielefeld, Amanda Sierra, Juan M Encinas, Mirjana Maletic-Savatic, Anne Anderson, Carlos P Fitzsimons
Lack of scientific reproducibility is a growing concern and weak experimental practices may contribute to irreproducibility. Here, we describe an optimized and versatile protocol for stereotaxic intrahippocampal administration of Kainic Acid (KA) in mice with a C57Bl6 background. In this protocol, KA administration is combined with in vivo recording of neuronal activity with wired and wireless setups. Following our protocol, KA administration results in a robust dose-dependent induction of low-level epileptiform activity or Status Epilepticus (SE) and induces previously characterized hallmarks of seizure-associated pathology...
2017: Frontiers in Neuroscience
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
Christian M Cabrera Kang, Nicolas Gaspard, Suzette M LaRoche, Brandon Foreman
PURPOSE: We conducted a survey of providers to assess for practice patterns in diagnosing and treating new-onset refractory status epilepticus (NORSE). NORSE is the occurrence of prolonged seizures that are not responsive to initial therapies in otherwise healthy individuals without obvious cause on initial presentation. This entity is thought to have multiple etiologies, including autoimmune. METHOD: A 29-question electronic survey was sent to providers included in the Neurocritical Care Society emailing list...
March 2017: Seizure: the Journal of the British Epilepsy Association
Mandy L Harris, Katherine M Malloy, Sheena N Lawson, Rebecca S Rose, William F Buss, Ulrike Mietzsch
We aimed to decrease practice variation in treatment of neonatal status epilepticus by implementing a standardized protocol. Our primary goal was to achieve 80% adherence to the algorithm within 12 months. Secondary outcome measures included serum phenobarbital concentrations, number of patients progressing from seizures to status epilepticus, and length of hospital stay. Data collection occurred for 6 months prior and 12 months following protocol implementation. Adherence of 80% within 12 months was partially achieved in patients diagnosed in our hospital; in pretreated patients, adherence was not achieved...
August 31, 2016: Journal of Child Neurology
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
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
Claudia Brandt, Marion Bankstahl, Kathrin Töllner, Rebecca Klee, Wolfgang Löscher
Rat strains such as Sprague-Dawley (SD) or Wistar are widely used in epilepsy research, including popular models of temporal lobe epilepsy in which spontaneous recurrent seizures (SRS), hippocampal damage, and behavioral alterations develop after status epilepticus (SE). Such rats are randomly outbred, and outbred strains are known to be genetically heterogeneous populations with a high intrastrain variation. Intrastrain differences may be an important reason for discrepancies between studies from different laboratories, but the extent to which such differences affect the development of seizures, neurodegeneration, and psychopathology in post-SE models of epilepsy has received relatively little attention...
August 2016: Epilepsy & Behavior: E&B
Stephane Legriel, Fernando Pico, Yves-Roger Tran-Dinh, Virginie Lemiale, Jean-Pierre Bedos, Matthieu Resche-Rigon, Alain Cariou
Convulsive status epilepticus (CSE) is a major medical emergency associated with a 50 % morbidity rate. CSE guidelines have recommended prompt management for many years, but there is no evidence to date that they have significantly improved practices or outcomes. Developing neuroprotective strategies for use after CSE holds promise for diminishing morbidity and mortality rates. Hypothermia has been shown to afford neuroprotection in various health conditions. We therefore designed a trial to determine whether 90-day outcomes in mechanically ventilated patients with CSE requiring management in the intensive care unit (ICU) are improved by early therapeutic hypothermia (32-34 °C) for 24 h with propofol sedation...
December 2016: Annals of Intensive Care
Anna Rosati, Lucrezia Ilvento, Manuela L'Erario, Salvatore De Masi, Annibale Biggeri, Giancarlo Fabbro, Roberto Bianchi, Francesca Stoppa, Lucia Fusco, Silvia Pulitanò, Domenica Battaglia, Andrea Pettenazzo, Stefano Sartori, Paolo Biban, Elena Fontana, Elisabetta Cesaroni, Donatella Mora, Paola Costa, Rosanna Meleleo, Roberta Vittorini, Alessandra Conio, Andrea Wolfler, Massimo Mastrangelo, Maria Cristina Mondardini, Emilio Franzoni, Kathleen S McGreevy, Lorena Di Simone, Alessandra Pugi, Lorenzo Mirabile, Federico Vigevano, Renzo Guerrini
INTRODUCTION: Status epilepticus (SE) is a life-threatening neurological emergency. SE lasting longer than 120 min and not responding to first-line and second-line antiepileptic drugs is defined as 'refractory' (RCSE) and requires intensive care unit treatment. There is currently neither evidence nor consensus to guide either the optimal choice of therapy or treatment goals for RCSE, which is generally treated with coma induction using conventional anaesthetics (high dose midazolam, thiopental and/or propofol)...
June 15, 2016: BMJ Open
Dale C Hesdorffer, Shlomo Shinnar, Daniel N Lax, John M Pellock, Douglas R Nordli, Syndi Seinfeld, William Gallentine, L Matthew Frank, Darrell V Lewis, Ruth C Shinnar, Jacqueline A Bello, Stephen Chan, Leon G Epstein, Solomon L Moshé, Binyi Liu, Shumei Sun
OBJECTIVES: To identify risk and risk factors for developing a subsequent febrile seizure (FS) in children with a first febrile status epilepticus (FSE) compared to a first simple febrile seizure (SFS). To identify home use of rescue medications for subsequent FS. METHODS: Cases included a first FS that was FSE drawn from FEBSTAT and Columbia cohorts. Controls were a first SFS. Cases and controls were classified according to established FEBSTAT protocols. Cumulative risk for subsequent FS over a 5-year period was compared in FSE versus SFS, and Cox proportional hazards regression was conducted...
July 2016: Epilepsia
Peter Camfield, Carol Camfield, Kathleen Nolan
A child with Dravet syndrome shakes family life to the core. Dravet syndrome usually has three phases: (1) up to 1-1½ years: with episodes of febrile status epilepticus but normal development; (2) age 1½ to ~6-10 years: with frequent seizures of varying types, developmental stagnation, behavioural and sleep problems; (3) after ~10 years: improvement in seizures, deteriorating gait, intellectual disability but some developmental gains. Complete seizure control is rare-simply prescribing medication is inadequate to help families...
June 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Elaine C Wirrell
Dravet syndrome is among the most challenging electroclinical syndromes. There is a high likelihood of recurrent status epilepticus; seizures are medically refractory; and patients have multiple co-morbidities, including intellectual disability, behaviour and sleep problems, and crouch gait. Additionally, they are at significant risk of sudden unexplained death. This review will focus predominantly on the prophylactic medical management of seizures, addressing both first-line therapies (valproate and clobazam) as well as second-line (stiripentol, topiramate, ketogenic diet) or later options (levetiracetam, bromides, vagus nerve stimulation)...
June 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
Helene Korvenius Nedergaard, Hanne Irene Jensen, Mette Stylsvig, Jørgen T Lauridsen, Palle Toft
BACKGROUND: The effects of non-sedation on cognitive function in critically ill patients on mechanical ventilation are not yet certain. This trial is a substudy of the NONSEDA trial where critically ill patients are randomized to non-sedation or to sedation with a daily wake-up attempt during mechanical ventilation in the intensive care unit (ICU). The aim of this substudy is to assess the effects of non-sedation versus sedation with a daily wake-up attempt on long-term cognitive function...
June 1, 2016: Trials
Jonathan E Kurz, Samuel M Poloyac, Nicholas S Abend, Anthony Fabio, Michael J Bell, Mark S Wainwright
OBJECTIVES: Early posttraumatic seizures may contribute to worsened outcomes after traumatic brain injury. Evidence to guide the evaluation and management of early posttraumatic seizures in children is limited. We undertook a survey of current practices of continuous electroencephalographic monitoring, seizure prophylaxis, and the management of early posttraumatic seizures to provide essential information for trial design and the development of posttraumatic seizure management pathways...
July 2016: Pediatric Critical Care Medicine
Concetta Ilenia Palermo, Carmela Maria Costanzo, Concetta Franchina, Giacomo Castiglione, Loretta Giuliano, Raffaela Russo, Alessandro Conti, Vito Sofia, Guido Scalia
Human Parvovirus B19 (PVB19), the etiological agent of the fifth disease, is associated with a large spectrum of pathologies, among which is encephalitis. Since it has been detected from the central nervous system in children or in immunocompromised patients, its causative role in serious neurological manifestations is still unclear. Here we report the case of an 18-year-old healthy boy who developed encephalitis complicated by prolonged status epilepticus. The detection of PVB19 DNA in his serum and, subsequently, in his cerebrospinal fluid supports the hypothesis that this virus could potentially play a role in the pathogenesis of neurological complications...
July 2016: Journal of Clinical Virology: the Official Publication of the Pan American Society for Clinical Virology
Teia Kobulashvili, Julia Höfler, Judith Dobesberger, Florian Ernst, Philippe Ryvlin, J Helen Cross, Kees Braun, Petia Dimova, Stefano Francione, Hrvoje Hecimovic, Christoph Helmstaedter, Vasilios K Kimiskidis, Morten Ingvar Lossius, Kristina Malmgren, Petr Marusic, Bernhard J Steinhoff, Paul Boon, Dana Craiu, Norman Delanty, Daniel Fabo, Antonio Gil-Nagel, Alla Guekht, Edouard Hirsch, Reetta Kalviainen, Ruta Mameniskiené, Çiğdem Özkara, Margitta Seeck, Guido Rubboli, Pavel Krsek, Sylvain Rheims, Eugen Trinka
PURPOSE: The European Union-funded E-PILEPSY network aims to improve awareness of, and accessibility to, epilepsy surgery across Europe. In this study we assessed current clinical practices in epilepsy monitoring units (EMUs) in the participating centers. METHOD: A 60-item web-based survey was distributed to 25 centers (27 EMUs) of the E-PILEPSY network across 22 European countries. The questionnaire was designed to evaluate the characteristics of EMUs, including organizational aspects, admission, and observation of patients, procedures performed, safety issues, cost, and reimbursement...
May 2016: Seizure: the Journal of the British Epilepsy Association
C L Jones, J Koios
Convulsive status epilepticus (SE) is a medical emergency where successful treatment is associated with timely intervention and the use of a protocol has been recommended to provide the highest quality of care. Despite this, there is no nationally available protocol for the treatment of SE in adults in Australia. Treatment is therefore variable and often based on international guidelines or familiarity with certain medications. We have developed an Australian-based algorithm for the treatment of SE, focusing on simplifying management while delivering the safest possible care...
April 2016: Internal Medicine Journal
S Auvin
The ketogenic diet is a high-fat, low-protein, low-carbohydrate diet that has been employed as a non-pharmacologic therapy for refractory epilepsy. Several multicenter and two randomized studies have demonstrated the efficacy of the ketogenic diet and the modified Atkins diet for children and adolescent with pharmacoresitant epilepsy. In order to facilitate patient tolerability and palatability, the diet protocols are gradually modified including changes in ratios of the fat versus non-fat components and the initiation of the diet with or without fasting...
March 2016: Revue Neurologique
Luisa Santos Pereira, Vanessa Teixeira Müller, Marleide da Mota Gomes, Alexander Rotenberg, Felipe Fregni
Approximately one-third of patients with epilepsy remain with pharmacologically intractable seizures. An emerging therapeutic modality for seizure suppression is repetitive transcranial magnetic stimulation (rTMS). Despite being considered a safe technique, rTMS carries the risk of inducing seizures, among other milder adverse events, and thus, its safety in the population with epilepsy should be continuously assessed. We performed an updated systematic review on the safety and tolerability of rTMS in patients with epilepsy, similar to a previous report published in 2007 (Bae EH, Schrader LM, Machii K, Alonso-Alonso M, Riviello JJ, Pascual-Leone A, Rotenberg A...
April 2016: Epilepsy & Behavior: E&B
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