S01. Third-line antiepileptic treatment outcomes in refractory status epilepticus

2018 ◽  
Vol 129 ◽  
pp. e142
Author(s):  
Steven P. Ellis ◽  
Lola Morgan
Keyword(s):  
Status Epilepticus ◽  
Treatment Outcomes ◽  
Refractory Status Epilepticus ◽  
Antiepileptic Treatment ◽  
Refractory Status ◽  
Third Line

scholarly journals Anesthetic Use In Status Epilepticus: A Concise Review

2020 ◽  
pp. 20-36
Author(s):  
Furkan M. Yilmaz ◽  
Lauren A. Igneri ◽  
Yasir A. Yilmaz ◽  
Evren Burakgazi-Dalkilic
Keyword(s):  
Status Epilepticus ◽  
Recent Literature ◽  
Refractory Status Epilepticus ◽  
Clinical Use ◽  
Concise Review ◽  
Refractory Status ◽  
Line Therapy ◽  
Agent Selection ◽  
Third Line Therapy ◽  
Third Line

The purpose of this review is to summarize the recent literature focusing on intravenous (IV) administration of commonly used anesthetics, including midazolam, pentobarbital/ thiopental, propofol, and ketamine in the treatment of status epilepticus (SE). Anesthetics should be reserved as third-line therapy for the treatment of SE when benzodiazepines and other second-line agents fail to terminate the seizure. We have reviewed the literature related to the treatment of status epilepticus, refractory status epilepticus, super-refractory status epilepticus, anesthetics, midazolam, pentobarbital/thiopental, propofol, and ketamine. This paper focuses on the pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the treatment of SE with an emphasis on the developing literature supporting the use of ketamine for this indication. Based on the available literature, we propose recommendations for third-line agent selection in the management of SE.

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.

scholarly journals Early Combination Therapy of Ketamine and Midazolam in Patients with Refractory Status Epilepticus in Hemodynamic Unstable State

2021 ◽  
Vol 11 (2) ◽  
pp. 150-153
Author(s):  
Jung-Won Choi ◽  
Jung-Won Shin
Keyword(s):  
Status Epilepticus ◽  
Low Dose ◽  
Hemodynamic Instability ◽  
Systemic Circulation ◽  
Refractory Status Epilepticus ◽  
Unstable State ◽  
Concomitant Treatment ◽  
Refractory Status ◽  
Vasopressor Agents ◽  
Third Line

The use of anesthetics is inevitable to suppress seizure activity in refractory status epilepticus (RSE). Hypotension, which is a critical side effect observed when treating RSE using a higher dosage of anesthetics that enhance γ-aminobutyric acid (GABA) activity, often requires vasopressor agents. Concomitant treatment with N-methyl-D-aspartate (NMDA) receptor antagonists, such as ketamine, could be effective in prolonged refractory SE, while maintaining stable blood pressure owing to the blockage of catecholamine reuptake in the systemic circulation. We report two cases of patients who had RSE with hemodynamic instability treated promptly with an early combination of ketamine and low-dose midazolam. The combination treatment effectively suppressed epileptic discharge with less hemodynamic side effects; moreover, a low dose of midazolam was required when combined with ketamine therapy. The initial combination of a third-line therapy that blocks NMDA receptors with enhanced GABAergic activity could be useful in RSE. Further studies are necessary in many variable etiologies of SE.

scholarly journals Ketamine Infusion for Super Refractory Status Epilepticus in Alternating Hemiplegia of Childhood

2020 ◽  
Vol 51 (03) ◽  
pp. 225-228 ◽  
Author(s):  
Debopam Samanta
Keyword(s):  
Status Epilepticus ◽  
Neurodevelopmental Disorder ◽  
Refractory Status Epilepticus ◽  
Human Case ◽  
The Body ◽  
Gabaergic Interneuron ◽  
Ketamine Infusion ◽  
Alternating Hemiplegia Of Childhood ◽  
Refractory Status ◽  
Third Line

AbstractAlternating hemiplegia of childhood (AHC) is a rare neurodevelopmental disorder and characterized by infantile onset hemiplegia involving either side of the body and other paroxysmal spells, including epilepsy. The N-methyl-D-aspartate (NMDA) receptor noncompetitive antagonist ketamine has been proved to be effective terminating status epilepticus (SE) in animal models and human case studies. Less than 50 cases, those use ketamine, have been reported in the management of pediatric SE, but its effectiveness is unknown in patients with AHC. The author reported two patients with molecularly confirmed AHC who presented with super refractory status epilepticus. These two patients failed multiple antiepileptic drugs, including midazolam infusion and propofol but responded promptly to ketamine infusion. This is the first description of the effectiveness of ketamine as an effective third-line agent for super refractory SE associated with AHC. Increased glutamate-mediated neurotoxicity can be present in AHC, not only due to overexpression of glutamate receptors during status epilepticus but also due to unique characteristics of AHC-preferential inactivity of GABAergic interneuron and impaired action of glutamate transporters (EAAT-1). Moreover, as neuroregression is possible after SE in AHC, earlier termination of SE by using ketamine can be an effective option in this population. Further prospective, controlled studies are needed to confirm the finding of this study.

scholarly journals New-Onset Refractory Status Epilepticus: More Investigations, More Questions

2016 ◽  
Vol 8 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Philippe Dillien ◽  
Susana Ferrao Santos ◽  
Vincent van Pesch ◽  
Vanessa Suin ◽  
Sophie Lamoral ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Immune Therapy ◽  
Healthy Woman ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
The Status ◽  
Third Line Therapy ◽  
High Doses ◽  
Third Line ◽  
New Onset

A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

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