scholarly journals Advances in the management of generalized convulsive status epilepticus: what have we learned?

Brain ◽  
2021 ◽  
Author(s):  
Aidan Neligan ◽  
Sanjeev Rajakulendran ◽  
Matthew C. Walker
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
The Past ◽  
Class A ◽  
Adults And Children

Abstract Convulsive status epilepticus is the most serious manifestation of an epileptic diathesis. In the early stages (5–30 min), there exists class A evidence to support the efficacy of benzodiazepines as first-line treatment. As status epilepticus progresses into the later stages, the evidence for treatment becomes less robust until we are depending upon short case series and case reports for the treatment of refractory status epilepticus. However, the past year saw the publication of three randomized controlled trials in the setting of benzodiazepine-resistant established convulsive status epilepticus: the EcLiPSE and ConSEPT studies, compared levetiracetam to phenytoin in children; and the ESETT study compared fosphenytoin, levetiracetam and sodium valproate in adults and children. In addition, the emergence of data from the SENSE study, a multicentre multinational prospective cohort study and the publication of a systematic review and meta-analysis of the mortality of status epilepticus over the past 30 years, has brought the treatment of status epilepticus into sharp focus. In this update we provide a detailed analysis of these studies and their impact on clinical practice. We review contentious areas of management in status epilepticus where a consensus is lacking and advance the case for more research on existing and alternative treatment strategies.

scholarly journals The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

2017 ◽  
Vol 01 (03) ◽  
pp. E204-E210
Author(s):  
Stephanie Gollwitzer ◽  
Hajo Hamer
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Evidence Based ◽  
New Approach ◽  
Refractory Status ◽  
First Choice ◽  
Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

scholarly journals Consensus Protocol for the Treatment of Super-Refractory Status Epilepticus

2018 ◽  
Vol 31 (10) ◽  
pp. 598 ◽  
Author(s):  
Daniel Gomes ◽  
José Pimentel ◽  
Carla Bentes ◽  
Diana Aguiar de Sousa ◽  
Ana Patrícia Antunes ◽  
...  
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Intensive Care Units ◽  
Case Reports ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Refractory Status Epilepticus ◽  
Consensus Protocol ◽  
Level Of Evidence ◽  
Refractory Status

Introduction: Super-refractory status epilepticus is defined as status epilepticus that persists or recurs 24 hours after anaesthetic therapy onset or after its withdrawal. It is mostly found in intensive care units and carries high mortality but good long-term prognosis for those who survive. In contrast with the initial phases of status epilepticus, treatment lacks strong scientific evidence and is mostly derived from case reports or small case series.Objective: To propose a protocol for the treatment of super-refractory status epilepticus in level III intensive care units, focusing on the treatment strategies to control clinical and/or electroencephalographic epileptic activity.Material and Methods: Narrative review of the literature by PubMed search. Available evidence was discussed in consensus meetings by intensive care and neurology experts’ from a level III intensive care unit and one of the Portuguese reference centres for the treatment of refractory epilepsy, respectively.Results: Anaesthetics with the highest level of evidence are propofol, midazolam, thiopental and ketamine. These represent the basis of the treatment of super-refractory status epilepticus and should be used in combination with antiepileptic drugs. The level of evidence for the latter is lower, however, levetiracetam, topiramate, pregabalin, lacosamide, valproic acid, phenytoin and perampanel may be recommended. Alternative therapeutic strategies with very low level of evidence are recommended in cases of total absence of clinical response, such as magnesium sulphate, pyridoxine, ketogenic diet, therapeutic hypothermia and immunosupression.Conclusion: We propose a treatment protocol based on a sequential combination of anaesthetics, anti-epileptic drugs and alternative therapies. Strategies to evaluate treatment response and to wean drugs based on clinical results are also proposed.

scholarly journals Electroencephalographic abnormalities in COVID-19-related encephalopathies: A systematic review

2020 ◽  
Vol 8 (35) ◽  
pp. 36-41
Author(s):  
Jie Pan ◽  
Shazma Khan ◽  
Smathorn Thakolwiboon ◽  
Dargelis Chi
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Neurological Complication ◽  
Case Series ◽  
Convulsive Status Epilepticus ◽  
Acute Encephalopathy ◽  
Case Control Studies ◽  
Retrospective Case ◽  
Epileptiform Discharges ◽  
Slow Activity

Background: Acute encephalopathy is a common neurological manifestation in coronavirus disease 2019 (COVID-19) patients and presents with confusion, delirium, or poor responsiveness. Non-convulsive status epilepticus (NCSE) is an important differential diagnosis in this situation. The electroencephalography (EEG) patterns in COVID-19 patients remain largely unknown. Method: A literature search was conducted on MEDLINE, EMBASE, and Cochrane database. Eligibility criteria included case series and case reports of COVID-19 patients with neurological complication who underwent EEG. Two authors screened all resulting studies and extracted the data independently. Results: Four retrospective case control studies and eleven case reports were identified. Background diffuse slow activity were seen in most of the COVID-19 patients. Other EEG patterns reported included status epilepticus, focal slow activity, rhythmic periodic discharges, and interictal epileptiform discharges. Imaging and CSF studies were available in only a few patients. Conclusions: Acute encephalopathy is common in the context of COVID-19. There is no specific EEG pattern found in these patients. Keywords: COVID-19, coronavirus, SAR-CoV-2, electroencephalogram, EEG

Lacosamide for the Treatment of Refractory Status Epilepticus

2011 ◽  
Vol 45 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Erica M Fernandez ◽  
Andrew J Franck
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Current Evidence ◽  
Refractory Status ◽  
Successful Termination ◽  
Study Selection ◽  
Animal Data

Objective: To evaluate current evidence for the use of lacosamide in the treatment of refractory status epilepticus. Data Sources: Literature was accessed via PubMed (through July 2011) using the terms lacosamide and status epilepticus. Study Selection and Data Extraction: All reports on the use of lacosamide in patients with status epilepticus were included for evaluation. Reviews and animal data were excluded. Data Synthesis: Treatment of status epilepticus is challenging, and most patients fail to respond to initial treatment. Recently, several reports have been published on the use of lacosamide for status epilepticus. Eleven reports (5 case reports and 6 case series) were identified. Lacosamide was credited with successful termination of status epilepticus in a majority of these reports, However, the data are weakened by the heterogeneity of the reports, their descriptive nature, and the common divergence from current recommendations for the treatment of status epilepticus, Conclusions: While lacosamide has been reported as an effective treatment for refractory status epilepticus, there is insufficient evidence for its routine use. For cases in which the risks associated with anesthetizing drugs are believed to outweigh the benefits, such as in complex partial status epilepticus, lacosamide may be a reasonable option after more established drug therapies fail.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals Risk of colectomy after conservative treatment of diverticulitis of the left hemicolon complicated by abdominal or pelvic abscess: protocol of a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042350
Author(s):  
Maximilian Sohn ◽  
Ayman Agha ◽  
Igors Iesalnieks ◽  
Anna Tiefes ◽  
Alfred Hochrein ◽  
...  
Keyword(s):  
Systematic Review ◽  
Emergency Surgery ◽  
Case Reports ◽  
Acute Diverticulitis ◽  
Meta Analysis ◽  
Case Series ◽  
Pelvic Abscess ◽  
Risk Of Bias ◽  
Cochrane Central Register ◽  
Review Manager

IntroductionAcute diverticulitis of the sigmoid colon is increasingly treated by a non-operative approach. The need for colectomy after recovery from a flare of acute diverticulitis of the left colon, complicated diverticular abscess is still controversial. The primary aim of this study is to assess the risk of interval emergency surgery by systematic review and meta-analysis.Methods and analysisThe systematic review and meta-analysis will be conducted in accordance to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and EMBASE will be screened for the predefined searching term: (Diverticulitis OR Diverticulum) AND (Abscess OR pelvic abscess OR pericolic abscess OR intraabdominal abscess) AND (surgery OR operation OR sigmoidectomy OR drainage OR percutaneous drainage OR conservative therapy OR watchful waiting). All studies published in an English or German-speaking peer-reviewed journal will be suitable for this analysis. Case reports, case series of less than five patients, studies without follow-up information, systematic and non-systematic reviews and meta-analyses will be excluded. Primary endpoint is the rate of interval emergency surgery. Using the Review Manager Software (Review Manager/RevMan, V.5.3, Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration, 2012) meta-analysis will be pooled using the Mantel-Haenszel method for random effects. The Risk of Bias in Non-randomized Studies of Interventions tool will be used to assess methodological quality of non-randomised studies. Risk of bias in randomised studies will be assessed using the Cochrane developed RoB 2-tool.Ethics and disseminationAs no new data are being collected, ethical approval is exempt for this study. This systematic review is to provide a new insight on the need for surgical treatment after a first attack of acute diverticulitis, complicated by intra-abdominal or pelvic abscesses. The results of this study will be presented at national and international meetings and published in a peer-reviewed journal.PROSPERO registration numberCRD42020164813.

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

scholarly journals Challenges in Evaluation and Management of Children with Myocardial Bridging

Cardiology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nurdan Erol
Keyword(s):  
Congenital Anomaly ◽  
Coronary Artery ◽  
Case Reports ◽  
Case Series ◽  
Diagnosis And Treatment ◽  
Myocardial Bridging ◽  
Small Case Series ◽  
Adults And Children ◽  
Artery Branch

Myocardial bridging (MB) is a congenital anomaly where a coronary artery branch or group of branches extends inside a tunnel consisting of myocardium. Although it is mostly considered “benign,” it is reported that MB may lead to significant cardiac problems and sudden cardiac deaths. While it is a congenital anomaly, its symptoms usually arise at further ages rather than childhood. The literature on MB in children is in the form of case reports or small case series. This is why pediatric cases are assessed in the light of information obtained from adults. This review compiled the literature on MB in adults and children and compared it, as well as discussing questions arising regarding the clinic, diagnosis, and treatment of MB.

Not all patients with convulsive status epilepticus intubated in pre-hospital settings meet the criteria for refractory status epilepticus

Seizure ◽  
2021 ◽  
Vol 88 ◽  
pp. 29-35
Author(s):  
Sinead Zeidan ◽  
Benjamin Rohaut ◽  
Hervé Outin ◽  
Francis Bolgert ◽  
Marion Houot ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Refractory Status
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