scholarly journals Management of Status Epilepticus

1998 ◽  
Vol 25 (S1) ◽  
pp. S4-S6 ◽  
Author(s):  
Michael J. Aminoff
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Status Epilepticus ◽  
General Anesthesia ◽  
Brain Damage ◽  
Response To Treatment ◽  
Motor Activities ◽  
Pharmacologic Management ◽  
Convulsive Seizures ◽  
Electroencephalogram Eeg

AbstractThe pharmacologic management of major motor status epilepticus is summarized. When general anesthesia is required, the electroencephalogram (EEG) is used for monitoring the adequacy of treatment. The EEG findings may also be important in recognizing status epilepticus and monitoring its response to treatment when this is clinically difficult, as when it occurs in comatose or pharmacologically paralyzed patients or in the context of severe brain damage. Finally, the EEG helps to clarify the nature of motor activities of uncertain basis in patients in the intensive care unit and has indicated that non-convulsive seizures or status are more common than clinically suspected in such patients.

scholarly journals Should the CIWA-Ar be the standard monitoring strategy for alcohol withdrawal syndrome in the intensive care unit?

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Tessa L. Steel ◽  
Shewit P. Giovanni ◽  
Sarah C. Katsandres ◽  
Shawn M. Cohen ◽  
Kevin B. Stephenson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Alternative Measure ◽  
Icu Patients ◽  
Verbal Responses

Abstract Background The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is commonly used in hospitals to titrate medications for alcohol withdrawal syndrome (AWS), but may be difficult to apply to intensive care unit (ICU) patients who are too sick or otherwise unable to communicate. Objectives To evaluate the frequency of CIWA-Ar monitoring among ICU patients with AWS and variation in CIWA-Ar monitoring across patient demographic and clinical characteristics. Methods The study included all adults admitted to an ICU in 2017 after treatment for AWS in the Emergency Department of an academic hospital that standardly uses the CIWA-Ar to assess AWS severity and response to treatment. Demographic and clinical data, including Richmond Agitation-Sedation Scale (RASS) assessments (an alternative measure of agitation/sedation), were obtained via chart review. Associations between patient characteristics and CIWA-Ar monitoring were tested using logistic regression. Results After treatment for AWS, only 56% (n = 54/97) of ICU patients were evaluated using the CIWA-Ar; 94% of patients had a documented RASS assessment (n = 91/97). Patients were significantly less likely to receive CIWA-Ar monitoring if they were intubated or identified as Black. Conclusions CIWA-Ar monitoring was used inconsistently in ICU patients with AWS and completed less often in those who were intubated or identified as Black. These hypothesis-generating findings raise questions about the utility of the CIWA-Ar in ICU settings. Future studies should assess alternative measures for titrating AWS medications in the ICU that do not require verbal responses from patients and further explore the association of race with AWS monitoring.

scholarly journals The impact of EEG in the diagnosis and management of patients with acute impairment of consciousness

2012 ◽  
Vol 70 (1) ◽  
pp. 34-39 ◽  
Author(s):  
João A. G. Ricardo ◽  
Marcondes C. França Jr. ◽  
Fabrício O. Lima ◽  
Clarissa L. Yassuda ◽  
Fernando Cendes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Room ◽  
Medical Management ◽  
Clinical Management ◽  
Epileptiform Activity ◽  
Acute Setting ◽  
Diagnosis And Management ◽  
The Impact ◽  
Electroencephalogram Eeg

OBJECTIVES: To assess the frequency of electroencephalogram (EEG) requests in the emergency room (ER) and intensive care unit (ICU) for patients with impairment of consciousness (IC) and its impact in the diagnosis and management. METHODS: We followed patients who underwent routine EEG from ER and ICU with IC until discharge or death. RESULTS: During the study, 1679 EEGs were performed, with 149 (8.9%) from ER and ICU. We included 65 patients and 94 EEGs to analyze. Epileptiform activity was present in 42 (44.7%). EEG results changed clinical management in 72.2% of patients. The main reason for EEG requisition was unexplained IC, representing 36.3% of all EEGs analyzed. Eleven (33%) of these had epileptiform activity. CONCLUSION: EEG is underused in the acute setting. The frequency of epileptiform activity was high in patients with unexplained IC. EEG was helpful in confirming or ruling out the suspected initial diagnosis and changing medical management in 72% of patients.

Status Epilepticus

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 939-940
Author(s):  
JEAN AICARDI ◽  
JEAN-JACQUES CHEVRIE
Keyword(s):  
Status Epilepticus ◽  
Brain Damage ◽  
Mortality And Morbidity ◽  
Considerable Evidence ◽  
Convulsive Seizures

Concerning the article by Maytal and colleagues and the accompanying editorial by Freeman, we have also found that the mortality and morbidity of cryptogenic status epilepticus has decreased considerably since our 1970 paper. Likewise, the incidence of acquired hemiplegia in France has become low during the same period. Contrary to Maytal et al, however, we believe that better and earlier control of convulsive status has played a role in this decrease. There is considerable evidence that convulsive seizures can produce brain damage, irrespective of the cause of attacks.

Sign in / Sign up

Export Citation Format

Share Document