scholarly journals Convulsive Status Epilepticus in a Cohort of Patients from a Peruvian Academic Hospital

2021 ◽  
Vol 11 (1) ◽  
pp. 83-92
Author(s):  
Marcelo Bedoya-Sommerkamp ◽  
Victor Hugo Chau-Rodríguez ◽  
Jesús Medina-Ranilla ◽  
Alejandro Escalaya-Advíncula ◽  
Ray Ticse-Aguirre ◽  
...  
Keyword(s):  
Emergency Department ◽  
Developing Countries ◽  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Academic Hospital ◽  
Post Discharge ◽  
Hospital Arrival ◽  
Line Therapy ◽  
Neurologic Emergency

Background and Purpose: Status epilepticus is a neurologic emergency whose epidemiology, etiology and management are scarcely known in developing countries. Our objective was to describe the demographic and clinical features as well as the management of generalized convulsive status epilepticus (GCSE) in adult patients admitted to the emergency department of an academic hospital in Peru, between March 2019 and March 2020.Methods: Observational study of a prospective cohort in which patients were assessed by the emergency and neurology department on the first day of hospitalization, at discharge and at 30 days post-discharge in a follow-up visit. Relevant demographics and clinical data were collected. After being encoded and sorted, univariate statistical analysis was carried out.Results: Of the sample of 59 patients, 62.7% were males, 57.6% were unemployed, 89.8% did not finish high school, and 55.9% had intermittent GCSE with no seizure at arrival. The total calculated median times were: 60 minutes from GCSE onset to hospital arrival, 110 minutes from GCSE onset to 1st line therapy, and 7 minutes from hospital arrival to 1st line therapy. The most frequently used antiepileptic drugs were one dose of benzodiazepine (41.7%), phenytoin (76.9%), and additional doses of benzodiazepines (60%) for 1st, 2nd, and 3rd line therapies, respectively. The most frequent etiologies were antiepileptic drug suspension (27.1%), undetermined (25.4%) and acute stroke (11.8%). 62.71% had 0-2 modified Rankin score at discharge.Conclusions: In this cohort of patients, GCSE was mainly intermittent. Management times differed from the guidelines’ recommendations.

scholarly journals Factors Associated with Family Physician Follow-up 30 Days Post-discharge from a Local Canadian Community Emergency Department

Cureus ◽  
2020 ◽  
Author(s):  
Kelly Lien ◽  
Barrett A Grattan ◽  
Alexandra L Reynard ◽  
Jocelynn Peters ◽  
Jennifer L Parr
Keyword(s):  
Emergency Department ◽  
Family Physician ◽  
Post Discharge ◽  
Factors Associated

scholarly journals Decreased Cerebrospinal Fluid Orexin-A (Hypocretin-1) Concentrations in Patients after Generalized Convulsive Status Epilepticus

2020 ◽  
Vol 9 (10) ◽  
pp. 3354
Author(s):  
Mojdeh Samzadeh ◽  
Ewa Papuć ◽  
Marzena Furtak-Niczyporuk ◽  
Konrad Rejdak
Keyword(s):  
Cerebrospinal Fluid ◽  
Status Epilepticus ◽  
Neuronal Damage ◽  
Study Groups ◽  
Convulsive Status Epilepticus ◽  
Orexin A ◽  
Diagnostic Lumbar Puncture ◽  
Turn Over ◽  
Hypocretin 1

The effects of status epilepticus on the orexin/hypocretin system have yet to be investigated. The present study aimed to assay orexin-A/hypocretin-1 in the cerebrospinal fluid (CSF) of patients after generalized convulsive status epilepticus (GCSE). The study groups included 20 GCSE patients, 24 patients diagnosed with epilepsy but remaining in remission (ER), and 25 normal controls (CTR). Diagnostic lumbar puncture was performed in GCSE patients within 3–10 days of seizure cessation, as well as in the ER and to CTR subjects. Among all GCSE patients, the outcome was graded according to the modified Rankin Scale (mRS) at 1-month follow-up. Orexin-A levels were measured in unextracted CSF samples, using a commercial radioimmunoassay. There was a significant overall difference in median CSF orexin-A concentrations between GCSE, RE, and CTR patients (p < 0.001). The lowest concentrations were noted in the GCSE group compared to ER (p < 0.001) or CTR (p < 0.001). CSF orexin-A levels in GCSE patients inversely correlated with clinical outcome as assessed on the mRS at 1-month follow-up (r = −0.55; p = 0.1). In conclusion, CSF orexin-A levels may serve as a biomarker of increased turn-over of the peptide or post-SE neuronal damage, and implicates the orexin system in the pathogenesis of SE.

scholarly journals Association of guideline publication and delays to treatment in pediatric status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (9) ◽  
pp. e1222-e1235
Author(s):  
Iván Sánchez Fernández ◽  
Nicholas S. Abend ◽  
Marta Amengual-Gual ◽  
Anne Anderson ◽  
Ravindra Arya ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Status Epilepticus ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Pediatric Patients ◽  
Convulsive Status Epilepticus ◽  
Hospital Arrival ◽  
Time To Treatment ◽  
Patient Interviews ◽  
Record Review

ObjectiveTo determine whether publication of evidence on delays in time to treatment shortens time to treatment in pediatric refractory convulsive status epilepticus (rSE), we compared time to treatment before (2011–2014) and after (2015–2019) publication of evidence of delays in treatment of rSE in the Pediatric Status Epilepticus Research Group (pSERG) as assessed by patient interviews and record review.MethodsWe performed a retrospective analysis of a prospectively collected dataset from June 2011 to September 2019 on pediatric patients (1 month–21 years of age) with rSE.ResultsWe studied 328 patients (56% male) with median (25th–75th percentile [p25–p75]) age of 3.8 (1.3–9.4) years. There were no differences in the median (p25–p75) time to first benzodiazepine (BZD) (20 [5–52.5] vs 15 [5–38] minutes, p = 0.3919), time to first non-BZD antiseizure medication (68 [34.5–163.5] vs 65 [33–142] minutes, p = 0.7328), and time to first continuous infusion (186 [124.2–571] vs 160 [89.5–495] minutes, p = 0.2236). Among 157 patients with out-of-hospital onset whose time to hospital arrival was available, the proportion who received at least 1 BZD before hospital arrival increased after publication of evidence of delays (41 of 81 [50.6%] vs 57 of 76 [75%], p = 0.0018), and the odds ratio (OR) was also increased in multivariable logistic regression (OR 4.35 [95% confidence interval 1.96–10.3], p = 0.0005).ConclusionPublication of evidence on delays in time to treatment was not associated with improvements in time to treatment of rSE, although it was associated with an increase in the proportion of patients who received at least 1 BZD before hospital arrival.

scholarly journals Subcortical nuclei volumes are associated with cognition in children post-convulsive status epilepticus: Results at nine years follow-up

2020 ◽  
Vol 110 ◽  
pp. 107119
Author(s):  
Kyle H. Bennett ◽  
Suresh S. Pujar ◽  
Marina M. Martinos ◽  
Christopher A. Clark ◽  
Michael Yoong ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Subcortical Nuclei

scholarly journals Status epilepticus as presenting manifestation of H1N1 infection

2015 ◽  
Vol 02 (02) ◽  
pp. 084-086 ◽  
Author(s):  
Aastha Takkar ◽  
Manoj Goyal ◽  
Manish Modi ◽  
Parampreet Kharbanda ◽  
Lakshminarayana Yaddanapudi ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Antiviral Treatment ◽  
Neurological Complications ◽  
Clinical Findings ◽  
Convulsive Status Epilepticus ◽  
H1n1 Pandemic ◽  
H1n1 Infection ◽  
Serological Tests ◽  
History Of

Abstract Background During the global H1N1 pandemic, neurological complications were reported in approximately 6–10% of children suffering from H1N1 infection, but only rarely in adults. Generalized convulsive status epilepticus (GCSE) as a presenting manifestation of H1N1 infection in an adult is exceedingly rare and has not been reported in literature. We report a patient who presented to us with GCSE as a presenting manifestation of H1N1 infection who improved following appropriate antiviral treatment. Methods and results This 20-year-old gentleman presented to us with history of fever followed by GCSE of 24 h duration. He was treated symptomatically and was evaluated in detail. He was diagnosed to be suffering from H1N1 infection based on appropriate serological tests. After start of antiviral therapy, he improved and is doing well at 4 months follow up. Conclusion This case report further expands the spectrum of clinical findings associated with sporadic H1N1 infection. A possibility of H1N1 infection should be considered in all patients who present with GCSE without any obvious cause so that appropriate diagnostic tests and treatment can be carried out at the earliest.

scholarly journals Pain in the Emergency Department with One-Week Follow-Up of Pain Resolution

2005 ◽  
Vol 10 (2) ◽  
pp. 67-70 ◽  
Author(s):  
C Celeste Johnston ◽  
Anita J Gagnon ◽  
Carolyn J Pepler ◽  
Patricia Bourgault
Keyword(s):  
Emergency Department ◽  
Visual Analogue Scale ◽  
Pain Intensity ◽  
Musculoskeletal Pain ◽  
Analogue Scale ◽  
Attitudes And Beliefs ◽  
Post Discharge ◽  
Residual Pain ◽  
Normal Functions

OBJECTIVES: To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post-discharge, and the postdischarge treatment of pain.METHODS: Patients (n=871) admitted to two urban, university-affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self-reported, and chart reviews of the assessment, immediate treatment and follow-up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585).RESULTS: Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One-quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities.CONCLUSIONS: More than one-third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.

scholarly journals Older Patients’ Perspectives on Factors Contributing to Frequent Visits to the Emergency Department: A Qualitative Interview Study

2020 ◽  
Author(s):  
Daisy Kolk ◽  
Anton F. Kruiswijk ◽  
Janet L. MacNeil-Vroomen ◽  
Milan L. Ridderikhof ◽  
Bianca M. Buurman
Keyword(s):  
Emergency Department ◽  
Acute Care ◽  
Older Patients ◽  
Structured Interviews ◽  
Post Discharge ◽  
Qualitative Interview Study ◽  
Before And After ◽  
Ed Visits ◽  
The Relationship

Abstract Background: Older patients are at high risk of unplanned revisits to the emergency department (ED) because of their medical complexity. To reduce the number of ED visits, we need more knowledge about the patient-level, environmental, and healthcare factors involved. The aim of this study was to collect older patients’ perspectives and experiences before and after an ED visit, and to identify factors that possibly contribute to frequent ED revisits.Methods: We performed semi-structured interviews with older patients who frequently visited the ED and were discharged home after an acute visit. Patients were enrolled in the ED of a university medical centre using purposive sampling to achieve maximum variation in heterogeneity. Interviews were recorded, transcribed, and coded independently by two researchers. Theoretical analysis was used to identify recurring patterns and themes in the data. Interviews were conducted until thematic saturation was reached.Results: In-depth interviews were completed with 13 older patients. Three main themes emerged: 1) medical events leading to feelings of crisis, 2) patients’ untreated health problems, and 3) persistent problems in health and daily functioning post discharge. Participants identified problems before and after their ED visit that possibly contributed to further ED visits. These problems included increasing symptoms leading to feelings of crisis, the relationship with the general practitioner, incomplete discharge information at the ED, and inadequate follow-up and lack of recovery after an ED visit.Conclusions: This qualitative study identified multiple factors that may contribute to frequent ED visits among older patients. Older patients in need of acute care might benefit from hospital-at-home interventions, or acute care provided by geriatric emergency teams in the primary care setting. Identifying frailty in the ED is needed to improve discharge communication and adequate follow-up is needed to improve recovery after an acute ED visit.

scholarly journals New-onset super-refractory status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2280-e2285 ◽  
Author(s):  
Elizabeth Matthews ◽  
Ayham Alkhachroum ◽  
Nina Massad ◽  
Riva Letchinger ◽  
Kevin Doyle ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Medical Center ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Refractory Status ◽  
New Onset

ObjectiveTo better understand the heterogeneous population of patients with new-onset refractory status epilepticus (NORSE), we studied the most severe cases in patients who presented with new-onset super-refractory status epilepticus (NOSRSE).MethodsWe report a retrospective case series of 26 adults admitted to the Columbia University Irving Medical Center neurologic intensive care unit (NICU) from February 2009 to February 2016 with NOSRSE. We evaluated demographics, diagnostic studies, and treatment course. Outcomes were modified Rankin Scale score (mRS) at hospital discharge and most recent follow-up visit (minimum of 2 months post discharge), NICU and hospital length of stay, and long-term antiepileptic drug use.ResultsOf the 252 patients with refractory status epilepticus, 27/252 had NORSE and 26/27 of those had NOSRSE. Age was bimodally distributed with peaks at 27 and 63 years. The majority (96%) had an infectious or psychiatric prodrome. Etiology was cryptogenic in 73%, autoimmune in 19%, and infectious in 8%. Seven patients (27%) underwent brain biopsy, autopsy, or both; 3 (12%) were diagnostic (herpes simplex encephalitis, candida encephalitis, and acute demyelinating encephalomyelitis). On discharge, 6 patients (23%) had good or fair outcome (mRS 0–3). Of the patients with long-term follow-up data (median 9 months, interquartile range 2–22 months), 12 patients (71%) had mRS 0–3.ConclusionAmong our cohort, nearly all patients with NORSE had NOSRSE. The majority were cryptogenic with few antibody-positive cases identified. Neuropathology was diagnostic in 12% of cases. Although only 23% of patients had good or fair outcome on discharge, 71% met these criteria at follow-up.

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