scholarly journals Lidocaine for status epilepticus in adults

2015 ◽  
Vol 42 (S1) ◽  
pp. S17-S17
Author(s):  
FA Zeiler ◽  
KJ Zeiler ◽  
CJ Kazina ◽  
J Teitelbaum ◽  
LM Gillman ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Patient Outcomes ◽  
Seizure Control ◽  
Adult Population ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Refractory Status ◽  
Lidocaine Administration ◽  
Grade Methodology ◽  
Clinical Trials Registry

Introduction: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in adults for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Overall, 13 studies were identified, with 11 manuscripts and 2 meeting abstracts. Seventy-six adult patients were treated for 82 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 1 to 12, on board prior to lidocaine therapy. During 69 of the 82 (84.1%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied significantly. Overall, 70.7% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 64.1% and 6.1% respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists level 4, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the adult population. Further prospective studies of lidocaine administration in this setting are warranted.

scholarly journals CACN Chair’s Select Abstract Presentations

2015 ◽  
Vol 42 (S1) ◽  
pp. S7-S7
Author(s):  
FA Zeiler ◽  
KJ Zeiler ◽  
J Teitelbaum ◽  
LM Gillman ◽  
M West ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Patient Outcomes ◽  
Pediatric Population ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Infusion Therapy ◽  
Refractory Status ◽  
Select Abstract ◽  
Grade Methodology ◽  
Clinical Trials Registry

Introduction: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Overall, 20 original studies were identified, with 19 manuscripts and 1 meeting abstracts. Two hundred and thirty-five pediatric patients were treated for 252 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 2 to 8, on board prior to lidocaine therapy. During 20 of the 252 (7.9%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some utilizing bolus dosing alone; others utilizing a combination of bolus and infusion therapy. Overall, 60.0% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 57.6% and 12.3% respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists level 2b, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the pediatric population.

scholarly journals Lidocaine for Status Epilepticus in Pediatrics

2015 ◽  
Vol 42 (6) ◽  
pp. 414-426 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Kaitlin J. Zeiler ◽  
Jeanne Teitelbaum ◽  
Lawrence M. Gillman ◽  
Michael West ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Patient Outcomes ◽  
Pediatric Population ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Infusion Therapy ◽  
Assessment Development ◽  
Refractory Status ◽  
Lidocaine Administration ◽  
Clinical Trials Registry

AbstractBackgroundOur goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control.MethodsAll articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendations Assessment, Development, and Evaluation methodologies by two independent reviewers.ResultsOverall, 20 original studies were identified, with 19 manuscripts and one meeting abstract. Two hundred and thirty-five pediatric patients were treated for 252 episodes of SE/RSE. Patients had varying numbers of antiepileptic drugs (two to eight) on board before lidocaine therapy. During 20 of the 252 (7.9%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some using bolus dosing alone; others used a combination of bolus and infusion therapy. Overall, 60.0% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 57.6% and 12.3%, respectively. Patient outcomes were sparingly reported.ConclusionsThere currently exists Oxford level 2b, Grading of Recommendations Assessment Developement, and Evaluation C evidence to support the consideration of lidocaine for SE and RSE in the pediatric population. Further prospective studies of lidocaine administration in this setting are warranted.

scholarly journals Therapeutic Hypothermia for Refractory Status Epilepticus

2015 ◽  
Vol 42 (4) ◽  
pp. 221-229 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Kaitlin J. Zeiler ◽  
Jeanne Teitelbaum ◽  
Lawrence M. Gillman ◽  
Michael West
Keyword(s):  
Clinical Trials ◽  
Status Epilepticus ◽  
Therapeutic Hypothermia ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Seizure Reduction ◽  
Refractory Status ◽  
External Cooling ◽  
Grade Methodology ◽  
Clinical Trials Registry

AbstractBackground: Our goal was to perform a systematic review of the literature on the use of therapeutic hypothermia for refractory status epilepticus (RSE) and its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to May 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated by two independent reviewers, using both the Oxford and GRADE methodology. Results: Overall, 13 studies were identified, with 10 manuscripts and 3 meeting abstracts. A total of 40 patients were treated. The common target temperature was 33 degrees Celsius, sustained for a median 48 hours. Patients displayed a 62.5%, 15% and 22.5% rate of seizure cessation, seizure reduction, and failure of treatment respectively. External cooling was utilized in the majority of cases. Deep venous thrombosis, coagulopathy and infections were the commonly reported complications. Two ongoing clinical trials were identified. Conclusions: Oxford level 4, GRADE D evidence exists to support the use of therapeutic hypothermia to control seizures in RSE. Further prospective study is warranted.

scholarly journals Modern Inhalational Anesthetics for Refractory Status Epilepticus

2015 ◽  
Vol 42 (2) ◽  
pp. 106-115 ◽  
Author(s):  
Frederick A. Zeiler ◽  
Kaitlin J. Zeiler ◽  
Jeanne Teitelbaum ◽  
Lawrence M. Gillman ◽  
Michael West
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Reference Lists ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Assessment Development ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
Inhalational Anesthetic ◽  
Clinical Trials Registry

ABSTRACTBackground: Our goal was to perform a systematic review of the literature on the use of modern inhalational anesthetic agents for refractory status epilepticus and their impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to March 2014), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology by two independent reviewers. Results: Overall, 19 studies were identified, with 16 manuscripts and 3 meeting abstracts. A total of 46 patients were treated. Adult (n=28) and pediatric patients (n=18) displayed 92.9% and 94.4% seizure control with treatment, respectively. Isoflurane was used in the majority of cases. Hypotension was the only complication described. Conclusions: Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence exists to support the use of isoflurane in refractory status epilepticus to obtain burst suppression. Insufficient data exist to comment on the efficacy of desflurane and xenon at this time.

Intravenous Immunoglobulins for Refractory Status Epilepticus: A Scoping Systematic Review of the Pediatric Literature

2017 ◽  
Vol 15 (06) ◽  
pp. 305-315
Author(s):  
M. Matuszczak ◽  
J. Teitelbaum ◽  
C. Kazina ◽  
L. Gillman ◽  
F. Zeiler
Keyword(s):  
Systematic Review ◽  
Status Epilepticus ◽  
Pediatric Patients ◽  
Ivig Therapy ◽  
Intravenous Immunoglobulins ◽  
Refractory Status Epilepticus ◽  
Neurological Deficits ◽  
Cochrane Library ◽  
Refractory Status ◽  
Grade Methodology

AbstractOur goal was to perform a scoping systematic review of the literature on the use of intravenous immunoglobulins (IVIGs) for refractory status epilepticus (RSE) in pediatric patients. Articles from MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, ClinicalTrials.gov (inception to June 2016), reference lists of relevant articles, and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education (GRADE) methodology by two independent reviewers. We identified 21 original articles. Eighty-seven pediatric patients were described as having received IVIG therapy for RSE. The mean age was 7.8 years (range: 2–17.5 years). Seizure response occurred in 14 of the 87 patients (16.1%), with 3 (3.4%) and 11 (12.6%) displaying partial and complete responses, respectively. Seventy-three of the 87 patients (83.9%) failed to display any seizure response to IVIG therapy. No complications related to IVIG therapy were recorded. The majority of patients had moderate to severe neurological deficits upon follow-up. Oxford level 4, GRADE D evidence exists to suggest little to no impact on seizure control in pediatric autoimmune RSE. Routine use of IVIG for pediatric RSE cannot be recommended at this time and should be considered experimental.

scholarly journals Transcranial Magnetic Stimulation for Status Epilepticus

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
F. A. Zeiler ◽  
M. Matuszczak ◽  
J. Teitelbaum ◽  
L. M. Gillman ◽  
C. J. Kazina
Keyword(s):  
Status Epilepticus ◽  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Refractory Status Epilepticus ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Pediatric All ◽  
Grade Methodology ◽  
Clinical Trials Registry

Background. Our goal was to perform a systematic review on the use of repetitive transcranial magnetic stimulation (rTMS) in the treatment of status epilepticus (SE) and refractory status epilepticus (RSE). Methods. MEDLINE, BIOSIS, EMBASE, Global Health, Healthstar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform, clinicaltrials.gov (inception to August 2015), and gray literature were searched. The strength of evidence was adjudicated using Oxford and GRADE methodology. Results. We identified 11 original articles. Twenty-one patients were described, with 13 adult and 8 pediatric. All studies were retrospective. Seizure reduction/control with rTMS occurred in 15 of the 21 patients (71.4%), with 5 (23.8%) and 10 (47.6%) displaying partial and complete responses, respectively. Seizures recurred after rTMS in 73.3% of the patients who had initially responded. All studies were an Oxford level 4, GRADE D level of evidence. Conclusions. Oxford level 4, GRADE D evidence exists to suggest a potential impact on seizure control with the use of rTMS for FSE and FRSE, though durability of the therapy is short-lived. Routine use of rTMS in this context cannot be recommended at this time. Further prospective study of this intervention is warranted.

scholarly journals Super-refractory status epilepticus in a 29-year-old pregnant female

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110004
Author(s):  
Cinthya Carrasco ◽  
Audra Schwalk ◽  
Byungkwan Hwang ◽  
Kenneth Iwuji ◽  
Ebtesam Islam
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drugs ◽  
High Mortality ◽  
Safety Profile ◽  
Seizure Control ◽  
Prolonged Exposure ◽  
Refractory Status Epilepticus ◽  
Pregnant Female ◽  
Mortality And Morbidity ◽  
Refractory Status

Super-refractory status epilepticus is a rare medical and neurological emergency due to the high mortality and morbidity associated with this condition. Furthermore, there is very little data regarding its incidence, etiology, and management in the pregnant population with super-refractory status epilepticus. The treatment of super-refractory status epilepticus during pregnancy is specifically a major challenge as there are limited available therapeutic options due to the well-established teratogenicity of most antiepileptic drugs and the unknown safety profile of some of the anesthetics commonly used for seizure control. We report a case of successfully treated super-refractory status epilepticus in a 29-year-old, 26 weeks pregnant female who after an emergent delivery and prolonged exposure to multiple antiepileptic drugs recovered full neurological function.

scholarly journals Consciousness Recovery by Rituximab after Seizure Control in Cryptogenic New-Onset Refractory Status Epilepticus

2018 ◽  
Vol 11 (2) ◽  
pp. 137-142
Author(s):  
Tae-Won Yang ◽  
Jeong Won Jo ◽  
Do-Hyung Kim ◽  
Young-Soo Kim ◽  
Oh-Young Kwon
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
New Onset

scholarly journals Does burst-suppression achieve seizure control in refractory status epilepticus?

BMC Neurology ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
Kanitpong Phabphal ◽  
Suparat Chisurajinda ◽  
Thapanee Somboon ◽  
Kanjana Unwongse ◽  
Alan Geater
Keyword(s):  
Status Epilepticus ◽  
Seizure Control ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status

Successful Use of Inhalational Anesthesia and Electroconvulsive Therapy in a Child with New Onset Prolonged Super-Refractory Status Epilepticus

2021 ◽  
Author(s):  
Bharat Mehra ◽  
Ramakant Sabharwal ◽  
Anil Sachdev ◽  
Praveen Kumar ◽  
Rajiv Mehta ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Seizure Control ◽  
Febrile Illness ◽  
Refractory Status Epilepticus ◽  
Inhalation Anesthesia ◽  
Complete Control ◽  
Clear Cut ◽  
Refractory Status ◽  
New Onset

AbstractThe treatment of super-refractory status epilepticus (SRSE) and prolonged SRSE rests on urgent seizure control to minimize excitotoxic cerebral damage, other forms of neurologic damage, and multiple medical complications. To date no randomized controlled trials or clear-cut guidelines are available for the management of SRSE. We reported the case of a 10-year-old previously healthy male child patient who presented with a febrile illness and new onset prolonged SRSE that became refractory to multiple antiseizure medications (ASMs). Coma induction with anesthetic agents, 14 ASMs, ketogenic diet, immunotherapy failed to completely control the SRSE in our patient. On day 22, clinical and electroencephalographic seizure control was achieved with isoflurane inhalation anesthesia, which was continued for 3 weeks but was unable to be weaned. From day 57 onwards, electroconvulsive therapy was administered (total 14 sessions that resulted in complete control of seizures). He was discharged on the 80th day.

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