scholarly journals Super-Refractory Status Epilepticus Treated with High Dose Perampanel: Case Series and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Christopher R. Newey ◽  
Naresh Mullaguri ◽  
Stephen Hantus ◽  
Vineet Punia ◽  
Pravin George
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Critically Ill Patient ◽  
Unknown Etiology ◽  
High Dose ◽  
The Novel ◽  
Refractory Status ◽  
Symptomatic Seizures

Introduction. Acute symptomatic seizures are frequent in the critically ill patient and can be difficult to treat. The novel anticonvulsant perampanel may be effective in the treatment of status epilepticus considering its mechanism of action of being an AMPA antagonist. We present four cases of super refractory status epilepticus treated with high dose perampanel. Method. Case report. Cases. Four patients were treated with perampanel for their refractory status epilepticus. One patient had new onset refractory status epilepticus of unknown etiology. Three other patients had status epilepticus as a result of their cardiac arrest. Two of the cardiac arrest patients had myoclonus. In all patients, the additional of perampanel resulted in a reduction of seizure burden without affecting hemodynamics or hepatic or renal function. Conclusion. Perampanel may be effective in the treatment of super-refractory status epilepticus of varying etiologies. A larger, prospective study is needed to further assess this therapy.

scholarly journals New-onset super refractory status epilepticus: A case-series

Seizure ◽  
2020 ◽  
Vol 75 ◽  
pp. 174-184 ◽  
Author(s):  
Sidra Aurangzeb ◽  
Lara Prisco ◽  
Jane Adcock ◽  
Mahiri Speirs ◽  
Simon Raby ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
New Onset

Very-High-Dose Phenobarbital for Childhood Refractory Status Epilepticus

2006 ◽  
Vol 34 (1) ◽  
pp. 63-65 ◽  
Author(s):  
Wai Kin Lee ◽  
Kam Tim Liu ◽  
Betty Wan Yin Young
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
High Dose ◽  
Refractory Status ◽  
Very High

scholarly journals Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

Neurology ◽  
2018 ◽  
Vol 91 (23) ◽  
pp. e2153-e2162 ◽  
Author(s):  
Simone Beretta ◽  
Anna Coppo ◽  
Elisa Bianchi ◽  
Clara Zanchi ◽  
Davide Carone ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Neurologic Outcome ◽  
Low Flow ◽  
Prognostic Indicators ◽  
Prolonged Treatment ◽  
Periodic Pattern ◽  
Refractory Status ◽  
Eeg Pattern

ObjectiveTo investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns.MethodsIn the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns (benign, RSE, generalized periodic discharges [GPDs], malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months.ResultsRSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE started after 3 ± 2.3 days after cardiac arrest and lasted 4.7 ± 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%); a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively.ConclusionsAggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators.

scholarly journals Ketogenic diet for super-refractory status epilepticus: A case series and review of literature

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
VimalKumar Paliwal ◽  
Sucharita Anand ◽  
AmarS Vibhute ◽  
Ananya Das ◽  
Shilpi Pandey
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Review Of Literature ◽  
Refractory Status

High-dose midazolam therapy for refractory status epilepticus in children

2006 ◽  
Vol 32 (12) ◽  
pp. 2070-2076 ◽  
Author(s):  
Gavin Morrison ◽  
Elizabeth Gibbons ◽  
William Patrick Whitehouse
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
High Dose ◽  
Refractory Status

scholarly journals Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol

2020 ◽  
Vol 17 (11) ◽  
pp. 4023
Author(s):  
Beatriz García-López ◽  
Ana Isabel Gómez-Menéndez ◽  
Fernando Vázquez-Sánchez ◽  
Eva Pérez-Cabo ◽  
Francisco Isidro-Mesas ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Electroconvulsive Therapy ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
High Morbidity ◽  
General Anesthetics ◽  
Antiepileptic Treatment ◽  
Refractory Status ◽  
Feasible Option

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy.

Temporal lobectomy for refractory status epilepticus in a case of limbic encephalitis

2008 ◽  
Vol 109 (4) ◽  
pp. 742-745 ◽  
Author(s):  
Tracy Weimer ◽  
Warren Boling ◽  
David Pryputniewicz ◽  
Adriana Palade
Keyword(s):  
Status Epilepticus ◽  
Limbic Encephalitis ◽  
Seizure Activity ◽  
Refractory Status Epilepticus ◽  
Temporal Lobectomy ◽  
Bronchial Biopsy ◽  
High Dose ◽  
Refractory Status ◽  
The Right ◽  
The Brain

The authors report a case of status epilepticus secondary to limbic encephalitis that was successfully treated with temporal lobectomy. A 45-year-old woman presented in status epilepticus refractory to high-dose suppressive medical therapy. Magnetic resonance imaging of the brain showed T2- and FLAIR-weighted hyperintensities in the right temporal lobe, left and right frontal lobes, and pons. A lumbar puncture revealed normal findings. Continuous electroencephalography monitoring showed continued right temporal seizure activity. A paraneoplastic panel was positive for N-type voltage-gated calcium channels. Subsequent bronchial biopsy revealed small cell carcinoma of the lung. A right temporal lobectomy was performed due to refractory status, resulting in resolution of seizure activity and recovery of good neurological function. The authors describe their case and review the literature on surgical therapy for refractory status epilepticus and limbic encephalitis.

Ketamine infusion for refractory status epilepticus: A case report of cardiac arrest

2018 ◽  
Vol 47 ◽  
pp. 149-151 ◽  
Author(s):  
Lauren Koffman ◽  
Ho Yan Yiu ◽  
Salia Farrokh ◽  
John Lewin ◽  
Romergryko Geocadin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Ketamine Infusion ◽  
Refractory Status

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.

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