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 Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

2021 ◽  
Vol 2 (4) ◽  
pp. 3
Author(s):  
Sanum Kashif
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
High Grade Fever ◽  
Refractory Status ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Permanent Brain Damage

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

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 Treatment of refractory status epilepticus with electroconvulsive therapy: Need for future clinical studies

2017 ◽  
Vol 04 (01) ◽  
pp. 098-103 ◽  
Author(s):  
Anindya Ray
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Low Cost ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
Therapeutic Modality ◽  
Future Research ◽  
Systematic Research ◽  
Threatening Condition ◽  
Life Threatening

AbstractStatus epilepticus (SE) is a serious medical emergency. Refractory-SE non-responsive to anesthetic medication is a life threatening condition with very high mortality rate. Proper management of those cases is a big medical challenge. Over the last two decades there are anecdotal reports of successful management of such cases with electroconvulsive therapy (ECT) in 12 patients of different age group with variable pattern of seizures and different etiology. However, there is no systematic research about it. ECT is a well-known safe, easy- to-administer, low-cost therapeutic modality in the field of neuro-psychiatry. Thus its potential to treat refractory-SE which essentially lacks effective management should be evaluated in future research. The objectives of this article are to do a thorough literature review on use of ECT in refractory-SE; mechanism of action of ECT in refractory-SE; and finally formulate a working protocol for future study of using ECT in patients of refractory-SE.

Status Epilepticus—Work-Up and Management in Children

2020 ◽  
Vol 40 (06) ◽  
pp. 661-674
Author(s):  
Cristina Barcia Aguilar ◽  
Iván Sánchez Fernández ◽  
Tobias Loddenkemper
Keyword(s):  
Status Epilepticus ◽  
Medical Emergency ◽  
First Line ◽  
Timely Manner ◽  
Treatment Protocols ◽  
Efficacious Treatment ◽  
Life Threatening ◽  
Diagnostic Work ◽  
Work Up ◽  
Medication Choice

AbstractStatus epilepticus (SE) is one of the most common neurological emergencies in children and has a mortality of 2 to 4%. Admissions for SE are very resource-consuming, especially in refractory and super-refractory SE. An increasing understanding of the pathophysiology of SE leaves room for improving SE treatment protocols, including medication choice and timing. Selecting the most efficacious medications and giving them in a timely manner may improve outcomes. Benzodiazepines are commonly used as first line and they can be used in the prehospital setting, where most SE episodes begin. The diagnostic work-up should start simultaneously to initial treatment, or as soon as possible, to detect potentially treatable causes of SE. Although most etiologies are recognized after the first evaluation, the detection of more unusual causes may become challenging in selected cases. SE is a life-threatening medical emergency in which prompt and efficacious treatment may improve outcomes. We provide a summary of existing evidence to guide clinical decisions regarding the work-up and treatment of SE in pediatric patients.

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.

Status Epilepticus in Adults: A Review of Diagnosis and Treatment

2016 ◽  
Vol 36 (2) ◽  
pp. 62-73 ◽  
Author(s):  
Thomas Lawson ◽  
Susan Yeager
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drugs ◽  
Systematic Approach ◽  
Neuronal Damage ◽  
Rapid Diagnosis ◽  
Frequent Occurrence ◽  
Nonconvulsive Status Epilepticus ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Medical Emergency

Status epilepticus is a medical emergency that requires rapid diagnosis and treatment. Nonconvulsive status epilepticus is frequently underdiagnosed and therefore undertreated, which can lead to permanent neuronal damage resulting in disability or death. Despite the frequent occurrence and morbidity associated with status epilepticus, this topic has received little attention within the literature. A systematic approach to treatment should start with management of airway, breathing, and circulation, followed by administration of benzodiazepines and intravenous antiepileptic drugs, and rapid escalation of therapy to prevent morbidity and mortality. Armed with the information in this article, nurses will have a higher-level understanding of what to do when encountering a patient in status epilepticus.

scholarly journals Valproic acid as adjuvant treatment in generalized convulsive status epilepticus for adults admitted to the ICU on (VALSE): randomized double blind clinical trial (Preprint)

2020 ◽  
Author(s):  
Tarek Sharshar ◽  
Omar Ben Hadj Salem ◽  
Raphael Porcher ◽  
Lamiae Grimaldi ◽  
Nicholas Heming ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Status Epilepticus ◽  
Controlled Trial ◽  
Standard Of Care ◽  
Medical Emergency ◽  
Convulsive Status Epilepticus ◽  
Second Line ◽  
Double Blind ◽  
Good Tolerability ◽  
Intent To Treat

BACKGROUND Generalized convulsive status epilepticus (GCSE) is a frequent medical emergency. Treatment focuses on administration of benzodiazepines followed by a second line antiepileptic drug (AED). Despite this stepwise strategy, GCSE is not controlled in a quarter of patients and is associated with protracted hospitalization, high-mortality and long-term disability. OBJECTIVE We aimed to show that the administration of valproic acid (VPA) may be suited as a complement of the first and second-line treatment, because of antiepileptic efficacy, neuroprotective properties and good tolerability. METHODS We conducted a multicenter, double-blind, randomized controlled trial comparing VPA to placebo in adults admitted to intensive care units (ICU) for GCSE in France. All patients received standard of care including a benzodiazepine and a second-line AED (except VPA) at the discretion of the treating medical team. In the intervention arm, VPA was administered intravenously as a loading dose of 30mg/kg over 15 minutes followed by a continuous infusion of 1 mg/kg/h over the next 12 hours. In the placebo group, an identical IV administration of 0.9 % saline was used. The primary outcome was the proportion of patients discharged alive from hospital by day 15. Secondary outcomes were frequency of refractory and super-refractory GCSE; ICU-related morbidity; adverse events related to VPA, and cognitive dysfunction at 3 months. Statistical analyses will be performed according to the intent-to-treat principle. Ethics Committee of Saint-Germain-en-Laye, France, initial approval received on May 14 2012. Results will be disseminated via peer-reviewed publication and presentation at international conferences. RESULTS The first patient was randomized on February 18, 2013 and the last patient on July 7, 2018. 245 (99%) out of 248 planned patients were enrolled across 20 ICUs. At present, data management is still ongoing, and all parties involved in the trial remain blinded.Research CONCLUSIONS This is the first multicentre randomized double-blind controlled trial that assesses whether Valproic Acid can be useful as an adjuvant therapy to recommended first and second line anti-epileptic drugs for improving the outcome of GCSE. CLINICALTRIAL NCT01791868 (registered on May 2012).

Non-convulsive status epilepticus: mimics and chameleons

2018 ◽  
Vol 18 (4) ◽  
pp. 291-305 ◽  
Author(s):  
Michael Owen Kinney ◽  
John J Craig ◽  
P W Kaplan
Keyword(s):  
Intensive Care ◽  
Status Epilepticus ◽  
Adverse Effects ◽  
Neuronal Damage ◽  
Convulsive Status Epilepticus ◽  
Benefit Analysis ◽  
Out Of Hours ◽  
Intervention Specialists ◽  
Electroencephalogram Eeg ◽  
Risk Benefit Analysis

Non-convulsive status epilepticus (NCSE) is an enigmatic condition with protean manifestations. It often goes unrecognised, leading to delays in its diagnosis and treatment. The principal reason for such delay is the failure to consider and request an electroencephalogram (EEG), although occasional presentations have no scalp or surface electroencephalographic correlate. In certain settings with limited EEG availability, particularly out-of-hours, clinicians should consider treating without an EEG. Patients need a careful risk–benefit analysis to assess the risks of neuronal damage and harm versus the risks of adverse effects from various intensities of therapeutic intervention. Specialists in EEG, intensive care or epilepsy are invaluable in the management of patients with possible NCSE.

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.

Treatment of Classic Syndromes in Idiopathic Focal Epilepsies in Childhood

2016 ◽  
Vol 05 (03) ◽  
pp. 142-146 ◽  
Author(s):  
C. Panayiotopoulos ◽  
Thalia Valeta
Keyword(s):  
Status Epilepticus ◽  
Parental Education ◽  
Short Interval ◽  
Convulsive Status Epilepticus ◽  
Treatment Needs ◽  
Rolandic Epilepsy ◽  
Focal Seizures ◽  
First Choice ◽  
Parental Treatment ◽  
Panayiotopoulos Syndrome

Of the classic syndromes of idiopathic (benign) focal epilepsies in childhood, more than half of children with Rolandic epilepsy and Panayiotopoulos syndrome do not need antiepileptic drug (AED) treatment. Monotherapy with carbamazepine, levetiracetam, sodium valproate, or clobazam is usually recommended for those with seizures that are unusually frequent (more than three), lengthy, distressing, or otherwise significantly interfering with the child's life. Other factors in favor of treatment include a short interval between the first three seizures, a younger age of onset (less than 4 years), or a presence of recurrent tonic–clonic seizures and diurnal seizures. In contrast to Rolandic epilepsy and Panayiotopoulos syndrome that may not need treatment, idiopathic childhood occipital epilepsy of Gastaut should be treated because seizures are frequent and secondarily generalized convulsions are probably unavoidable without medication. It is likely that all AEDs licensed as monotherapy for focal seizures and mainly carbamazepine and levetiracetam are suitable.The electroencephalogram does not predict prognosis or AED treatment needs, though there are views supporting that interictal spikes have an adverse effect on cognition.Strategies of withdrawing medication in idiopathic focal epilepsies in childhood differ among experts, although all agree that there is no need to continue medication 1 to 3 years after the last seizure, and certainly not after the age of 14 years, when most benign childhood focal seizures remit, or age 16, when they are practically nonexistent.In the acute stage of status epilepticus, control of the seizures is of paramount importance. Convulsive status epilepticus is a life threatening condition and should be terminated as soon as possible. Autonomic status epilepticus needs thorough evaluation for proper diagnosis and management. Benzodiazepines, intravenously, in rectal or buccal preparations are commonly used to terminate long lasting seizures and status epilepticus. Early parental treatment is more effective than late emergency treatment. Buccal midazolam is probably the first choice medication for out-of-hospital termination of status epilepticus.Parental education and psychological support are the cornerstone of the optimal management because despite excellent prognosis, idiopathic focal epilepsies in childhood usually have a dramatic impact to parents.

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