Status Epilepticus

2019 ◽  
pp. 687-692
Author(s):  
Christopher P. Robinson ◽  
Sara E. Hocker
Keyword(s):  
Status Epilepticus ◽  
Neurocritical Care ◽  
Seizure Activity ◽  
Nonconvulsive Status Epilepticus ◽  
Care Society ◽  
Recurrent Seizure ◽  
Neurologic Emergency

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.

scholarly journals Sudden altered mental state in the elderly: nonconvulsive status epilepticus and the role of the Emergency Department

2011 ◽  
Vol 5 (1) ◽  
pp. 15-25
Author(s):  
Rocco Galimi
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
The Elderly ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Recurrent Seizure ◽  
Memory Problems ◽  
Altered Mental State ◽  
New Onset

In the elderly, new onset of epilepsy is often associated with vague complaints such as confusion, altered mental status, or memory problems. The absence of clinically apparent convulsions in association with an electroencephalogram showing continuous or recurrent seizure activity has been called nonconvulsive status epilepticus (NCSE). The purpose of this article is to describe the clinical and electroencephalographic features of NCSE in older adults. NCSE is an important, under-recognised and reversible cause of acute prolonged confusion. Although attempts have been made to define and classify this disorder, there is no universally accepted definition or classification yet that encompasses all subtypes or electroclinical scenarios. A urgent electroencephalogram is considered as the method of choice in the diagnostic evaluation of NCSE. Further researches are needed to better define NCSE.

Intracranial hypotension masquerading as nonconvulsive status epilepticus

2014 ◽  
Vol 120 (3) ◽  
pp. 624-627 ◽  
Author(s):  
Vishnumurthy Shushrutha Hedna ◽  
Abhay Kumar ◽  
Bayard Miller ◽  
Sharathchandra Bidari ◽  
Arash Salardini ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Intracranial Hypotension ◽  
Care Setting ◽  
Neurocritical Care ◽  
Clinical Status ◽  
Subsequent Treatment ◽  
Nonconvulsive Status Epilepticus ◽  
Metabolic Dysfunction ◽  
Csf Pressure ◽  
Orthostatic Symptoms

Intracranial hypotension (IH) has been a known entity in neurocritical care since 1938. Even though many cases are spontaneous, the incidence of intracranial hypotension in the neurocritical care setting is increasing by virtue of the increased number of neurosurgical interventions. Whether spontaneous or secondary in etiology, diagnosis of IH usually requires the presence of orthostatic symptoms, including headaches and nausea with low opening CSF pressure. However, typical clinical features in the appropriate clinical context and imaging, even with normal CSF pressure, can indicate IH. In the neurocritical care setting, challenges for accurate semiology include altered sensorium and reduced levels of responsiveness for which many etiologies may exist, including metabolic dysfunction, traumatic brain injury, IH, or nonconvulsive status epilepticus (NCSE). The authors describe 3 patients whose clinical picture and electroencephalography (EEG) findings initially suggested NCSE but who did not respond to treatment with antiepileptic drugs alone. Neuroimaging suggested IH, and subsequent treatment of IH successfully improved the patient's clinical status. To the authors' knowledge this paper is the first in the literature that reports a correlation of IH with electrographic findings similar to NCSE as cause and effect. The authors' hypothesis is that thalamocortical dysfunction causes EEG findings that appear to be similar to those in NCSE but that these conditions do not coexist. The EEG activity is not epileptogenic, and IH results in blocking network pathways producing thalamocortical dysfunction. The authors discuss the hypothesis and pathophysiology of these epileptiform changes in relation to IH.

Status Epilepticus

2021 ◽  
pp. 473-478
Author(s):  
Maximiliano A. Hawkes ◽  
Sara E. Hocker
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
Second Line ◽  
Antiepileptic Agents ◽  
Anesthetic Agents ◽  
Initiation Of Therapy ◽  
Neurologic Emergency ◽  
Recovery Of Consciousness

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting more than 5 minutes or recurrent seizures without recovery of consciousness in between. When seizures persist despite adequate doses of first- and second-line antiepileptic agents, the condition is called refractory SE. Super-refractory SE occurs when seizure activity continues or recurs 24 hours after the initiation of therapy with anesthetic agents.

Generalized convulsive status epilepticus after retrograde type A aortic dissection surgery

Perfusion ◽  
2020 ◽  
pp. 026765912094315
Author(s):  
Yuan Li ◽  
Qingchen Wu ◽  
Haoming Shi ◽  
Dan Chen ◽  
Cheng Zhang
Keyword(s):  
Status Epilepticus ◽  
Aortic Dissection ◽  
Seizure Activity ◽  
Good Condition ◽  
Type A ◽  
Convulsive Status Epilepticus ◽  
Recurrent Seizure ◽  
Type A Aortic Dissection ◽  
Generalized Seizures ◽  
First Time

Introduction: Generalized convulsive status epilepticus is defined as a generalized and convulsive seizure with 5 minutes or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures. For the first time, we present a case with retrograde type A aortic dissection after endovascular repairment and received thoracotomy intensely. Case report: The patient experienced frequent generalized seizures in the immediate postoperative period, and status epilepticus was considered for his medical history, clinic symptoms and related examinations. Discussion and Conclusion: Generalized convulsive status epilepticus should be alert for avoiding delay in the rehabilitation particularly after aortic dissection surgery. Under the good condition of ventilation, combining morphine with midazolam or diazepam can more effectively relieve the symptoms.

scholarly journals Status Epilepticus Management: A Short Review

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Martin Savard MD
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
Short Review ◽  
High Morbidity ◽  
First Line ◽  
Recurrent Seizure ◽  
Electrographic Seizure ◽  
History Of ◽  
Medical Teams ◽  
Based Medicine

Status epilepticus is a common neurological emergency, with high morbidity and mortality, now defined as 5 minutes or more of (1) continuous clinical and/or electrographic seizure activity or (2) recurrent seizure activity without recovery (returning to baseline) between seizures. In observational studies, many disparities exist in management among different medical teams. Here, the author reviews evidence-based medicine data on this management, with emphasis on the use of drugs and electroencephalography. Benzodiazepine (either IV lorazepam or IM midazolam) are the recognized first line of treatment. When a patient is still seizing thereafter, the second line is usually either IV phenytoin or IV valproate, where available. A persisting status epilepticus should then be considered as refractory and managed with anaesthetic drug, keeping in mind that the natural history of that state is to evolve to nonconvulsive status epilepticus, where an emergent EEG is the only way to diagnose that condition with certainty.

scholarly journals CLINICAL PROFILE AND OUTCOME OF CHILDREN ADMITTED WITH STATUS EPILEPTICS

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Sushil Kuamr Bakolia ◽  
Gajendra Kumar Verma ◽  
Dinesh Kumar Barolia
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
Cross Sectional Study ◽  
Clonic Seizure ◽  
Clinical Profile ◽  
Convulsive Status Epilepticus ◽  
Age Group ◽  
Cross Sectional ◽  
Recurrent Seizure ◽  
Appropriate Treatment

Background: Objective of this study was to study epidemiology and clinical profile of Status epilepticus Methods: Hospital based cross sectional study conducted on 50 children All children aged between 1 month to 12 years who at presentation or during the PICU stay had convulsive status epilepticus - defined as continuous seizure activity or recurrent seizure activity without regaining consciousness lasting for >5 min. Results: Among 50 children 56.00 % were in the age group were less than 5 years ,24 % were between 6-10 years ,20.00 % were above 10 yrs. The mean age group was 6.21±1.26 years. Incidence was higher in males (64%) when compared to females (36%). Generalized tonic clonic seizure were observed in 46 (92.00%) and partial seizure was noted in 4 (8%) of the children. About 36 (72%) of the children developed SE for the first time. Conclusion: Status epilepticus is one of the common neurological emergency which requires admission to PICU. In our study epilepsy is one of the most common causes of status epilepticus. Early and appropriate treatment with anticonvulsants and use of mechanical ventilation may improve the outcome. Keywords: Status epilepticus, mortality, clinical profile

scholarly journals Effects of Three Anti-Seizure Drugs on Cholinergic and Metabolic Activity in Experimental Status Epilepticus

2019 ◽  
Vol 22 ◽  
pp. 340-351 ◽  
Author(s):  
Imran Imran ◽  
Konrad Koch ◽  
Henrik Schöfer ◽  
Helene Lau ◽  
Jochen Klein
Keyword(s):  
Oxidative Stress ◽  
Valproic Acid ◽  
Status Epilepticus ◽  
Metabolic Activity ◽  
Seizure Activity ◽  
In Vivo Microdialysis ◽  
Ach Release ◽  
Recurrent Seizure ◽  
Pilocarpine Model

Purpose. Status epilepticus (SE) is characterized by recurrent seizure activity and can be drug-resistant. Knowledge of neuronal and metabolic activity of the brain during SE may be helpful to improve medical care. We here report the effects of three anti-seizure drugs on changes of acetylcholine energy metabolites and oxidative stress during SE. Methods. We used the lithium-pilocarpine model in rats to induce SE and in vivo-microdialysis to monitor cholinergic and metabolic activity in the hippocampus. We measured extracellular concentrations of acetylcholine, glucose, lactate, pyruvate, glycerol and isoprostanes before and during SE, and after acute treatment with pregabalin, valproic acid, and levetiracteam. Results. Upon onset of  SE, acetylcholine (ACh) release increased six- to eightfold. Glucose was increased only transiently by 30% but lactate levels rose four-fold, and extracellular concentrations of glycerol ten-fold. Isoprostanes are markers of oxidative stress and increased more than 20-fold. Two hours after pilocarpine adminstration, rats were treated with pregabalin (100 mg/kg), levetiracetam (200 mg/kg) or valproic acid (400 mg/kg) by i.p. injection. All three drugs stopped seizure activity in a delayed fashion, but at the doses indicated, only animals that received levetiracetam reached consciousness. All drugs reduced ACh release within 60-120 minutes. Lactate/pyruvate ratios, glycerol and isoprostanne levels were also reduced significantly after drug administration. Conclusions. Hippocampal ACh release closely follows seizure activity in SE and is attenuated when SE subsides. Pregabalin, valproic acid and levetiracetam all terminate seizures in the rat SE model and attenuate cholinergic and metabolic changes within two hours.

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