scholarly journals Parallel pathways of seizure generalization

Brain ◽  
2019 ◽  
Author(s):  
Natalia Dabrowska ◽  
Suchitra Joshi ◽  
John Williamson ◽  
Ewa Lewczuk ◽  
Yanhong Lu ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Entorhinal Cortex ◽  
Insular Cortex ◽  
Retrosplenial Cortex ◽  
Convulsive Status Epilepticus ◽  
Thalamic Nuclei ◽  
Systems Consolidation ◽  
Life Threatening ◽  
Frequent Site ◽  
Convulsive Seizures

Abstract Generalized convulsive status epilepticus is a life-threatening emergency, because recurrent convulsions can cause death or injury. A common form of generalized convulsive status epilepticus is of focal onset. The neuronal circuits activated during seizure spread from the hippocampus, a frequent site of seizure origin, to the bilateral motor cortex, which mediates convulsive seizures, have not been delineated. Status epilepticus was initiated by electrical stimulation of the hippocampus. Neurons transiently activated during seizures were labelled with tdTomato and then imaged following brain slice clearing. Hippocampus was active throughout the episode of status epilepticus. Neuronal activation was observed in hippocampus parahippocampal structures: subiculum, entorhinal cortex and perirhinal cortex, septum, and olfactory system in the initial phase status epilepticus. The tdTomato-labelled neurons occupied larger volumes of the brain as seizures progressed and at the peak of status epilepticus, motor and somatosensory cortex, retrosplenial cortex, and insular cortex also contained tdTomato-labelled neurons. In addition, motor thalamic nuclei such as anterior and ventromedial, midline, reticular, and posterior thalamic nuclei were also activated. Furthermore, circuits proposed to be crucial for systems consolidation of memory: entorhinal cortex, retrosplenial cortex, cingulate gyrus, midline thalamic nuclei and prefrontal cortex were intensely active during periods of generalized tonic-clonic seizures. As the episode of status epilepticus waned, smaller volume of brain was activated. These studies suggested that seizure spread could have occurred via canonical thalamocortical pathway and many cortical structures involved in memory consolidation. These studies may help explain retrograde amnesia following seizures.

A Comparison of Four Treatments for Generalized Convulsive Status Epilepticus

2018 ◽  
pp. 21-26
Author(s):  
Jason L. Sanders ◽  
Jarone Lee
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Line Treatment ◽  
First Line ◽  
Cooperative Study Group ◽  
Intention To Treat ◽  
Intravenous Diazepam ◽  
Life Threatening ◽  
First Line Treatment

Generalized convulsive status epilepticus (GCSE) is a life-threatening emergency, and multiple agents have been advocated for the initial treatment. The VA Status Epilepticus Cooperative Study Group conducted a randomized, blinded trial comparing intravenous diazepam followed by phenytoin, lorazepam, phenobarbital, or phenytoin as first-line treatment for GCSE. In the intention-to-treat analysis, no significant difference in treatment was observed across all groups for patients with either overt GCSE or subtle GCSE. Among patients with verified-diagnosis overt GCSE, lorazepam was most successful at achieving cessation of seizures, though no difference was observed among patients with verified-diagnosis subtle GCSE. Results from this trial and two others establish benzodiazepines as the favored first line treatment of GCSE. Investigations are ongoing comparing benzodiazepines to newer antiepileptic drugs. The Established Status Epilepticus Trial will be the first randomized trial comparing fosphenytoin, levetiracetam, and valproic acid for benzodiazepine-refractory status epilepticus in children and adults.

Notfallversorgung und Erstbehandlung epileptischer Anfälle im Erwachsenenalter

2019 ◽  
Vol 144 (02) ◽  
pp. 83-92
Author(s):  
Johannes Schiefer ◽  
Rainer Surges
Keyword(s):  
Status Epilepticus ◽  
Epileptic Seizures ◽  
Recurrence Risk ◽  
Brain Diseases ◽  
Convulsive Status Epilepticus ◽  
Mri Findings ◽  
Safety Measures ◽  
Anticonvulsant Treatment ◽  
Convulsive Seizures ◽  
Definition Of

AbstractSuspected epileptic seizures are a frequent cause of emergency hospital care. After single seizures, the emergency management includes safety measures and diagnostic efforts to distinguish epileptic seizures from its manifold mimics and to possibly detect acute causes of epileptic seizures. Convulsive status epilepticus requires rapid anticonvulsant treatment according to established protocols and diagnostics to rule out underlying acute brain diseases. After a first seizure, typical EEG- and MRI findings may indicate an elevated recurrence risk, thereby justifying the ultimate diagnosis of epilepsy and initiation of anticonvulsant therapy. This article reviews the recent definition of epilepsy, summarizes clinical characteristics of epileptic seizures and its mimics and provides an overview of established therapies of single convulsive seizures, convulsive status epilepticus and early care of adults after first unprovoked seizures.

Non-convulsive Status Epilepticus and Non-convulsive Seizures in Neurological ICU Patients

2014 ◽  
Vol 22 (2) ◽  
pp. 202-211 ◽  
Author(s):  
Ikuko Laccheo ◽  
Hasan Sonmezturk ◽  
Amar B. Bhatt ◽  
Luke Tomycz ◽  
Yaping Shi ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Icu Patients ◽  
Convulsive Seizures

scholarly journals Convulsive status epilepticus in children

2010 ◽  
Vol 63 (11-12) ◽  
pp. 801-804 ◽  
Author(s):  
Marija Knezevic-Pogancev ◽  
Ksenija Bozic ◽  
Tatjana Redzek-Mudrinic ◽  
Ksenija Gebauer-Bukurov
Keyword(s):  
Status Epilepticus ◽  
Neuronal Damage ◽  
Medical Emergency ◽  
Convulsive Status Epilepticus ◽  
Negative Effects ◽  
Rolandic Epilepsy ◽  
Febrile Convulsions ◽  
Early Management ◽  
Neurological Morbidity ◽  
Life Threatening

Introduction. Convulsive status epilepticus is the most urgent neurological medical emergency in children. Generalized convulsive status epilepticus is the most common and life-threatening type of status epilepticus. It is not a syndrome in the same sense as febrile convulsions, benign rolandic epilepsy, and infantile polymorphic epilepsy. These latter disorders have a tight age frame, seizure semiology, and a reasonably predictable outcome. Episodes of convulsive status epilepticus can occur in each: occasionally in symptomatic and febrile convulsions, and Lennox Gastaut syndrome, rarely in benign rolandic epilepsy, and West syndrome. Etiology of convulsive status epilepticus. Status epilepticus has many causes, which vary depending on the age and patient population. Convulsive status epileptucus continues to be associated with significant neurological morbidity and mortality, with different hazards and outcome. Although the outcome is dependent on etiology, it is known that appropriate early management may reduce mortality and some of the morbidity associated with convulsive status epilepticus. Discussion. Status epilepticus is a disorder in which the mechanisms attempting at terminating the seizure fail. Continued convulsive activity in convulsive status epilepticus results in decompensation of all organs and systems, thus being life threatening. Seizure activity in convulsive status epilepticus is associated with neuronal damage. The aim should be to halt this activity urgently, using, ideally, a 100% effective drug, administered quickly, without compromising the consciousness level or producing other negative effects on cardiovascular, respiratory function or other unexpected effects.

scholarly journals Nonconvulsive Status Epilepticus in Adults: Types, Pathophysiology, Epidemiology, Etiology, and Diagnosis

2017 ◽  
Vol 01 (03) ◽  
pp. E189-E203 ◽  
Author(s):  
Stephan Rüegg
Keyword(s):  
Status Epilepticus ◽  
Motor Neurons ◽  
Epidemiological Studies ◽  
Epileptic Activity ◽  
New Drugs ◽  
Nonconvulsive Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Neuronal Mechanisms ◽  
Nonconvulsive Seizures ◽  
Life Threatening

AbstractNonconvulsive status epilepticus (NCSE) is defined by permanent electroclinical nonconvulsive epileptic activity or a series of nonconvulsive seizures without recovery to baseline. This “silent” manifestation of lasting neurological symptoms, like aphasia, confusion, etc., impedes easily recognizing NCSE. The most important diagnostic step often is to consider the possibility of NCSE. NCSE can only be confirmed by an immediate EEG recording. Epidemiological studies show slight preponderance of convulsive status epilepticus (CSE) over NCSE (60:40%); however, this might result from lack of recognition of NCSE because of its very unspectacular manifestation. Regarding pathophysiology, the neuronal mechanisms are identical for both NCSE and CSE, but they spare the primary motor neurons. Permanent hyperexcitability may damage the neurons involved in NCSE the same way as the motor neurons in CSE. However, NCSE is spared from the life-threatening secondary pathophysiological sequelae of CSE (lactic acidosis, respiratory exhaustion, rhabdomyolsis, etc.). Nevertheless, autonomic dysregulation (arrhythmias (ventricular tachycardia/asystolia), apneas) may also expose the patient to substantial acute risks. There are a myriad of causes for NCSE and they are mainly medication errors (insufficient adherence or addition of new drugs with interactions) in patients with known epilepsy. In these patients and in those without known epilepsy, other causes include metabolic, toxic, structural (tumors, hemorrhages, ischemia), infectious, inflammatory, and autoimmune causes. Thus, it is germane to extensively search for the cause of the NCSE because the immediate and proper therapy of the underlying cause of, especially the acute symptomatic, forms of NCSE is at least as important as the antiictal treatment.

Convulsive and non-convulsive status epilepticus

2016 ◽  
Author(s):  
Matthew C. Walker
Keyword(s):  
Status Epilepticus ◽  
Prognostic Value ◽  
Seizure Activity ◽  
Clinical Manifestations ◽  
Convulsive Status Epilepticus ◽  
Epileptiform Discharges ◽  
Ictal Activity ◽  
Long Term Prognosis ◽  
Convulsive Seizures

This chapter describes the definition, epidemiology, classification, diagnosis, and treatment of status epilepticus, concentrating on the roles that electroencephalography (EEG) plays. The term status epilepticus now encompasses a range of conditions from continuous convulsive seizures to clinically subtle non-convulsive seizures, which may manifest as changes in behaviour or personality. EEG is critical for the diagnosis of non-convulsive status epilepticus. Furthermore, the progression of convulsive status epilepticus is to an electromechanical dissociation in which continuous electrical seizure activity may have no or minimal clinical manifestations. In the later stages of status epilepticus, EEG is necessary to monitor treatment, but is confounded by the interpretation of periodic EEG patterns, which represent a continuum from interictal through to ictal activity. Post-status epilepticus EEG patterns have prognostic value: periodic epileptiform discharges, burst suppression patterns (off anaesthesia) and repetitive seizure activity are indicative of a poor long-term prognosis.

scholarly journals Refractory convulsive status epilepticus in childhood

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 86-89
Author(s):  
Nikola Dimitrijevic ◽  
Dragana Bogicevic ◽  
Dimitrije Nikolic ◽  
Vesna Mitic ◽  
Nevenka Vunjak ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Anticonvulsant Drug ◽  
Convulsive Status Epilepticus ◽  
Symptomatic Therapy ◽  
Systemic Complications ◽  
Vital Functions ◽  
Neurologic Sequelae ◽  
Threatening Condition ◽  
Life Threatening ◽  
Overall Mortality

Refractory convulsive status epilepticus (RCSE) is life-threatening condition, with seizures lasting over one hour and not responding to first and second-line anticonvulsant drug therapy. Any mistreatment or delayed proper treatment significantly increase mortality and neurologic sequelae. First line drugs for convulsion ceasing are benzodiazepines, phenobarbital and phenytoin. In case of refractory status, infusion of midazolam and general anesthesia should be administered. The most important measures of the intensive care are control of vital functions, homeostasis, prevention and therapy for possible brain and systemic complications. Discovery of etiology of status epilepticus is highly important because symptomatic therapy should be administered. Overall mortality rate during RCSE is 13.5%, and is much higher in acute symptomatic group - 28.6%. Early sequelae rate is 40.6%, 27.3% and 70% in idiopathic and acute symptomatic groups, respectively.

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