Emergency Management of Epilepsy and Seizures

2019 ◽  
Vol 39 (01) ◽  
pp. 073-081 ◽  
Author(s):  
Carl Bazil ◽  
Anna Bank
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Emergency Department Visits ◽  
Emergency Physicians ◽  
Common Cause ◽  
Medical Evaluation ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures ◽  
New Onset

AbstractSeizure- and epilepsy-related complications are a common cause of emergency medical evaluation, accounting for 5% of 911 calls and 1% of emergency department visits. Emergency physicians and neurologists must be able to recognize and treat seizure- and epilepsy-related emergencies. This review describes the emergency evaluation and management of new onset seizures, breakthrough seizures in patients with known epilepsy, status epilepticus, acute symptomatic seizures, and acute adverse effects of antiepileptic drugs.

Management of Evacuee Surge from a Disaster Area: Solutions to Avoid Non-Emergent, Emergency Department Visits

2007 ◽  
Vol 22 (3) ◽  
pp. 220-223 ◽  
Author(s):  
Charlene B. Irvin ◽  
Jenny G. Atas
Keyword(s):  
Emergency Department ◽  
Hurricane Katrina ◽  
The United States ◽  
Emergency Department Visits ◽  
Disaster Area ◽  
Medical Evaluation ◽  
Number Of Patients ◽  
Medical Directors ◽  
States Experience ◽  
New Location

AbstractIntroduction:Many emergency departments (EDs) in the United States experience daily overcrowding, and a rapid influx of evacuees fleeing a disaster area can pose a substantial burden. Some of these evacuees may require ED care. However, others lack an alternative to the ED to address non-emergent medical concerns (prescription refills or outpatient referral).Objective:The objective of this study was to describe a successful multidisciplinary Hurricane Katrina Evacuation Center, explain the services offered, and determine the center's effects on referrals to local EDs.Methods:Data were collected concerning the number of patients utilizing the medical evaluation center and compared to the total number of evacuees to determine the proportion that utilized medical care. The data concerning patients given prescriptions was obtained by the estimation of the two medical directors of the Center, and therefore, is inexact.Results:During the five weeks the center was operational, 631 of 716 evacuees (88%) requested medical evaluation, and >80% of those had prescriptions written. Only four (<1%) patients were transported to local EDs.Conclusion:An evacuee evaluation center provides a convenient non-ED alternative for evacuees to address their non-emergent medical concerns and can be used to ease their transition to a new location.

Pediatric Seizures and Status Epilepticus

2020 ◽  
Author(s):  
Lindsey Retterath ◽  
Dale Woolridge
Keyword(s):  
Status Epilepticus ◽  
Pediatric Patients ◽  
Febrile Seizures ◽  
Pediatric Emergency ◽  
Initial Management ◽  
Symptomatic Seizures ◽  
Algorithmic Approaches ◽  
Work Up ◽  
Acute Symptomatic Seizures ◽  
Management Work

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures. This review contains 5 figures, 11 tables, and 22 references. Key Words: pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus 

scholarly journals New onset seizures an etiological study

2017 ◽  
Vol 4 (6) ◽  
pp. 1532
Author(s):  
Prakash B. ◽  
Arun B. J. ◽  
Ashok V. B. ◽  
Niranjan Nagaraj
Keyword(s):  
Complex Partial Seizure ◽  
Developed Countries ◽  
Cerebrovascular Accidents ◽  
The World ◽  
Etiological Spectrum ◽  
Etiological Study ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures ◽  
Cns Tuberculosis ◽  
New Onset

Background:Seizures are common disorders found all over the world and are encountered frequently during medical practice in variety of settings. Etiological spectrum of acute symptomatic seizures in developing countries is different from developed countries. So, this study was done to know the various etiologies of new onset seizures in adults in this region.Methods: Consecutive 100 Cases of new onset seizures from the Bhagwan Mahaveer Jain hospital, Bengaluru, were included in the study. The etiology was determined by neuroimaging and appropriate investigations including cerebrospinal fluid examination.Results: Of 100 patients 89% were acute symptomatic seizures. The seizure types were GTCS in 71% and 29% had simple or complex partial seizure (s) with or without secondary generalization. 8 (8%) patients had status epilepticus (SE). 40% 0f SE were caused by neuroinfections. Neuroinfection was the leading cause of seizure, which accounted for 34%, followed by Cerebrovascular accidents (29%) and metabolic (9%). Neurocysticercosis is most common cause in neuroinfection (35%), followed by meningitis (29%) and cerebral malaria (17%). 8% of seizures were because of CNS Tuberculosis. 55% of the CVA were due stroke and 34% due to CVT. 14% of seizures were pregnancy related.Conclusions: This study illustrates that the etiological spectrum of seizures in this part of the world is different from that described from developed countries and CNS infections account for a significant number of cases.  

scholarly journals Acute-on-chronic subdural hematoma: a new entity for prophylactic anti-epileptic treatment?

2020 ◽  
Author(s):  
Sae-Yeon Won ◽  
Daniel Dubinski ◽  
Thomas Freiman ◽  
Volker Seifert ◽  
Florian Gessler ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mortality Rate ◽  
Subdural Hematoma ◽  
Functional Outcomes ◽  
Chronic Subdural Hematoma ◽  
Control Group ◽  
Acute Bleeding ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures

Abstract Purpose Acute-on-chronic subdural hematoma (acSDH) describes acute bleeding into a chronic subdural hematoma (SDH), after surgery or second trauma. Because seizures are a well-known complication of SDH, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures (ASz), including status epilepticus, and determine the functional outcomes in this specific cohort of patients. Methods A retrospective analysis was performed, including patients with acSDH who were admitted to our department between 2010 and 2019. The incidence and timely onset of ASz and status epilepticus were evaluated. Functional outcomes at discharge and at 3–6 month follow-up were analyzed based on the modified Rankin scale. Results Of 506 patients with chronic SDH, 29 patients (5.7%) were diagnosed with acSDH. The overall incidence of ASz and status epilepticus were 72.4% and 10.3%, respectively. Favorable outcomes were identified in 11 patients (52.4%) in the ASz group compared with 6 patients (75%) in the non-ASz group. The mortality rate was higher in the ASz group compared with that in the control group (29% vs 0%). At follow-up, favorable outcomes were similar to those observed at discharge (52.4% in the ASz group and 71.4% in the control group). The mortality rate was still higher in the ASz group, at 32% compared with 14% for the control group. Conclusion AcSDH has a high risk for ASz, including status epilepticus, and is associated with unfavorable outcomes and high mortality. Thus, prophylactic treatment with antiepileptic drugs should be considered among this specific cohort of patients.

scholarly journals Hyperosmolar hyperglycaemic state causing atypical status epilepticus with hippocampal involvement

2021 ◽  
pp. practneurol-2021-003222
Author(s):  
Emanuele Bartolini ◽  
Raffaella Valenti ◽  
Josemir W Sander
Keyword(s):  
Status Epilepticus ◽  
Hippocampal Sclerosis ◽  
Convulsive Status Epilepticus ◽  
Epileptiform Discharges ◽  
Symptomatic Seizures ◽  
Mesial Temporal Lobe ◽  
Permanent Brain Damage ◽  
Acute Symptomatic Seizures

Diabetes mellitus may arise abruptly and decompensate suddenly, leading to a hyperglycaemic hyperosmolar state. Coma often ensues, although this usually reverses after the metabolic abnormalities have resolved. Acute symptomatic seizures can also occur in patients who are conscious, although these usually resolve after osmolarity and glycaemia have normalised. We describe an elderly woman who failed to regain vigilance despite prompt treatment; the cause was an unusual non-convulsive status epilepticus arising from the mesial temporal lobe and promoting a progressive and selective hippocampal involvement. During follow-up, her seizures recurred after stopping antiseizure medication and she developed hippocampal sclerosis, although she subsequently became seizure-free with antiseizure medications. Patients who are unresponsive in a hyperglycaemic hyperosmolar state may be having subclinical epileptiform discharges and risk developing permanent brain damage and long-term epilepsy.

scholarly journals Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis presenting to the emergency department with status epilepticus

CJEM ◽  
2014 ◽  
Vol 16 (05) ◽  
pp. 425-428 ◽  
Author(s):  
Brodie Nolan ◽  
Katharina Plenk ◽  
David Carr
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Mental Status ◽  
Young Patients ◽  
Complete Recovery ◽  
Altered Mental Status ◽  
Emergency Physicians ◽  
Varicella Zoster ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis

ABSTRACT Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a recently described and underdiagnosed entity that typically affects young, previously healthy individuals. Patients usually present in phases, which may include refractory seizures, psychosis, unresponsiveness, and autonomic instability. The diagnosis of anti-NMDAR encephalitis is challenging; however, prompt diagnosis and early treatment can lead to complete recovery. The incidence of anti-NMDAR encephalitis may be as high as four times that of encephalitis from herpes simplex, varicella-zoster, and West Nile viruses; however, it remains an underrecognized disorder. Early initiation of immunotherapy in anti-NMDAR encephalitis has been found to improve patient outcomes. Because of this, emergency physicians must be vigilant and consider this diagnosis in patients with altered mental status in whom a toxicologic or other etiology is not suspected. Early consideration of this diagnosis can facilitate urgent neurology consultation and prevent diagnostic delays arising from psychiatric referrals. It is essential to consider this diagnosis in suspicious emergency department presentations, particularly young patients who present with altered mental status, psychosis, or new-onset seizure activity when other obvious causes are ruled out. Emergency physicians should discuss the possibility of empirical intravenous immunoglobulin administration with neurology consultants if anti-NMDAR encephalitis is suspected. We describe the case of a 20-year-old man with anti-NMDAR encephalitis who presented to the emergency department with status epilepticus.

scholarly journals Possible levetiracetam induced encephalopathy presenting as electrical status epilepticus: An unknown occurrence

2014 ◽  
Vol 01 (02) ◽  
pp. 084-087 ◽  
Author(s):  
Rohan Mahale ◽  
Anish Mehta ◽  
Mahendra Javali ◽  
Suryanarayana Sharma ◽  
Byadaralli Madhusudhan ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Hepatic Encephalopathy ◽  
Broad Spectrum ◽  
Hepatic Metabolism ◽  
Renal Elimination ◽  
Anti Epileptic Drug ◽  
Proven Efficacy ◽  
Symptomatic Seizures ◽  
Acute Symptomatic Seizures ◽  
Metabolic Encephalopathies

AbstractLevetiracetam is a novel, broad spectrum anti-epileptic drug with proven efficacy in generalized as well as focal onset seizures. It has renal elimination with no hepatic metabolism. Levetiracetam induced encephalopathy is rarely reported in literature. Triphasic waves in the electroencephalogram are seen in toxic-metabolic encephalopathies of various aetiology like hepatic encephalopathy, uraemia. We report a patient who was on levetiracetam for acute symptomatic seizures and developed encephalopathy with electroencephalogram showing generalised triphasic waves. These triphasic waves disappeared with intravenous lorazepam but without clinical improvement in sensorium. The electroencephalographic abnormality appeared as electrical status epilepticus which got normalised on discontinuation of levetiracetam. This is the first report of levetiracetam induced encephalopathy presenting as electrical status epilepticus and also depicts electroencephalographic correlate of levetiracetam induced encephalopathy.

Pediatric Seizures and Status Epilepticus

2018 ◽  
Author(s):  
Lindsey Retterath ◽  
Dale Woolridge
Keyword(s):  
Status Epilepticus ◽  
Pediatric Patients ◽  
Febrile Seizures ◽  
Pediatric Emergency ◽  
Initial Management ◽  
Symptomatic Seizures ◽  
Algorithmic Approaches ◽  
Work Up ◽  
Acute Symptomatic Seizures ◽  
Management Work

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures. Key Words: Pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus 

scholarly journals Do Internists and Emergency Physicians Agree on the Appropriateness of Emergency Department Visits?

1997 ◽  
Vol 12 (3) ◽  
pp. 188-191 ◽  
Author(s):  
Gail M. O'Brien ◽  
Marc J. Shapiro ◽  
Mark J. Fagan ◽  
Robert W. Woolard ◽  
Patricia S. O'Sullivan ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visits ◽  
Emergency Physicians
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