Isoflurane in (Super-) Refractory Status Epilepticus: A Multicenter Evaluation

Abstract Background We aimed to determine the association between seizure termination and side effects of isoflurane for the treatment of refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) in neurointensive care units (neuro-ICUs). Methods This was a multicenter retrospective study of patients with RSE/SRSE treated with isoflurane for status epilepticus termination admitted to the neuro-ICUs of nine German university centers during 2011–2018. Results We identified 45 patients who received isoflurane for the treatment of RSE/SRSE. During isoflurane treatment, electroencephalograms showed no epileptiform discharges in 33 of 41 (80%) patients, and burst suppression pattern was achieved in 29 of 41 patients (71%). RSE/SRSE was finally terminated after treatment with isoflurane in 23 of 45 patients (51%) for the entire group and in 13 of 45 patients (29%) without additional therapy. Lengths of stay in the hospital and in the neuro-ICU were significantly extended in cases of ongoing status epilepticus under isoflurane treatment (p = 0.01 for length of stay in the hospital, p = 0.049 for length in the neuro-ICU). During isoflurane treatment, side effects were reported in 40 of 45 patients (89%) and mainly included hypotension (n = 40, 89%) and/or infection (n = 20, 44%). Whether side effects occurred did not affect the outcome at discharge. Of 22 patients with follow-up magnetic resonance imaging, 2 patients (9%) showed progressive magnetic resonance imaging alterations that were considered to be potentially associated with RSE/SRSE itself or with isoflurane therapy. Conclusions Isoflurane was associated with a good effect in stopping RSE/SRSE. Nevertheless, establishing remission remained difficult. Side effects were common but without effect on the outcome at discharge.

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Refractory status epilepticus associated with progressive magnetic resonance imaging signal change and hippocampal neuronal loss

Journal of Epilepsy ◽

10.1016/s0896-6974(96)00023-0 ◽

1996 ◽

Vol 9 (4) ◽

pp. 253-258 ◽

Cited By ~ 15

Author(s):

Carl E. Stafstrom ◽

Robert D. Tien ◽

Thomas J. Montine ◽

Rose-Mary Boustany

Keyword(s):

Magnetic Resonance Imaging ◽

Status Epilepticus ◽

Magnetic Resonance ◽

Neuronal Loss ◽

Refractory Status Epilepticus ◽

Resonance Imaging ◽

Refractory Status ◽

Magnetic Resonance Imaging Signal ◽

Signal Change

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Supramolecular Enhancement of Aminoxyl ORCA Contrast Agents

10.26434/chemrxiv.9640862.v1 ◽

2019 ◽

Author(s):

Hamilton Lee ◽

Jenica Lumata ◽

Michael A. Luzuriaga ◽

Candace Benjamin ◽

Olivia Brohlin ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Side Effects ◽

Magnetic Resonance ◽

Tobacco Mosaic Virus ◽

Contrast Agents ◽

Single Molecule ◽

Organic Radical ◽

Resonance Imaging ◽

Physiological Conditions

<div><div><div><p>Many contrast agents for magnetic resonance imaging are based on gadolinium, however side effects limit their use in some patients. Organic radical contrast agents (ORCAs) are potential alternatives, but are reduced rapidly in physiological conditions and have low relaxivities as single molecule contrast agents. Herein, we use a supramolecular strategy where cucurbit[8]uril binds with nanomolar affinities to ORCAs and protects them against biological reductants to create a stable radical in vivo. We further over came the weak contrast by conjugating this complex on the surface of a self-assembled biomacromolecule derived from the tobacco mosaic virus.</p></div></div></div>

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Norovirus Causes Pediatric Encephalopathy and Status Epilepticus: A Case Report and Review of the Literature

Journal of Pediatric Epilepsy ◽

10.1055/s-0041-1725990 ◽

2021 ◽

Author(s):

Gabriela Tantillo ◽

Navyamani Kagita ◽

Maite LaVega-Talbott ◽

Anuradha Singh ◽

David Kaufman

Keyword(s):

Magnetic Resonance Imaging ◽

Case Report ◽

Status Epilepticus ◽

Magnetic Resonance ◽

Review Of The Literature ◽

Resonance Imaging ◽

Common Cause ◽

Diffusion Restriction ◽

Neurologic Impairment ◽

Norovirus Gastroenteritis

AbstractNorovirus is a common cause of acute gastroenteritis outbreaks worldwide. The disease can present with varying degrees of neurologic impairment from benign convulsions to rare cases of severe encephalopathy. We describe a case report of a North American infant who presented with norovirus gastroenteritis, status epilepticus, severe encephalopathy, and abnormal but reversible diffusion restriction changes on magnetic resonance imaging of brain.

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Dietary Management of Children With Super-Refractory Status Epilepticus: A Systematic Review and Experience in a Single UK Tertiary Centre

Frontiers in Neurology ◽

10.3389/fneur.2021.643105 ◽

2021 ◽

Vol 12 ◽

Author(s):

Natasha E. Schoeler ◽

Zoe Simpson ◽

Runming Zhou ◽

Suresh Pujar ◽

Christin Eltze ◽

...

Keyword(s):

Status Epilepticus ◽

Side Effects ◽

Treatment Option ◽

Causal Effect ◽

Refractory Status Epilepticus ◽

Epilepsy Syndrome ◽

Drug Resistant ◽

Street Hospital ◽

Adverse Side Effects ◽

Refractory Status

Ketogenic diet therapies (KDT) are high-fat, low carbohydrate diets used as an effective treatment option for drug-resistant epilepsy. There is limited research on the efficacy of KDT for super-refractory status epilepticus (SRSE). We systematically review evidence for use of KDT in children with SRSE and present a single UK tertiary centre's experience. Thirty one articles were included, of which 24 were “medium” or “low” quality. One hundred and forty seven children with SRSE started KDT, of which 141 (96%) achieved ketosis. KDT was started mean 5.3 days (range 1–420) after status epilepticus (SE) started. SRSE resolved in 85/141 (60%) children after mean 6.3 days (range 0–19) post SE onset, but it is unclear whether further treatments were initiated post-KDT. 13/141 (9%) children died. Response to KDT was more likely when initiated earlier (p = 0.03) and in females (p = 0.01). Adverse side effects were reported in 48/141 (34%), mostly gastrointestinal; potentially serious adverse effects occurred in ≤4%. Eight children with SRSE, all diagnosed with febrile infection-related epilepsy syndrome, were treated with KDT at Great Ormond Street Hospital for Children. KDT was initiated enterally at mean day 13.6+/− 5.1 of admission. Seven of 8 (88%) children reported adverse side effects, which were potentially serious in 4/8 (50%), including metabolic acidosis, hypoglycaemia and raised amylase. SE ceased in 6/8 (75%) children after mean 25+/− 9.4 days post onset, but other treatments were often started concomitantly and all children started other treatments post-KDT. Two of 8 (25%) children died during admission and another died post-admission. Four of the remaining 5 children continue to have drug-resistant seizures, one of whom remains on KDT; seizure burden was unknown for one child. Our findings indicate that KDT is possible and safe in children with SRSE. Cessation of SRSE may occur in almost two-thirds of children initiated with KDT, but a causal effect is difficult to determine due to concomitant treatments, treatments started post-KDT and the variable length of time post-KDT onset when SRSE cessation occurs. Given that serious adverse side effects seem rare and response rates are (cautiously) favorable, KDT should be considered as an early treatment option in this group.

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