scholarly journals Toward evidence‐based severity assessment in rat models with repeated seizures: II. Chemical post–status epilepticus model

Epilepsia ◽  
2019 ◽  
Vol 60 (10) ◽  
pp. 2114-2127 ◽  
Author(s):  
Ines Koska ◽  
Roelof Maarten van Dijk ◽  
Isabel Seiffert ◽  
Valentina Di Liberto ◽  
Christina Möller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Evidence Based ◽  
Severity Assessment ◽  
Rat Models

scholarly journals Toward evidence‐based severity assessment in rat models with repeated seizures: III. Electrical post‐status epilepticus model

Epilepsia ◽  
2019 ◽  
Vol 60 (8) ◽  
pp. 1539-1551 ◽  
Author(s):  
Isabel Seiffert ◽  
Roelof Maarten van Dijk ◽  
Ines Koska ◽  
Valentina Di Liberto ◽  
Christina Möller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Evidence Based ◽  
Severity Assessment ◽  
Rat Models

scholarly journals Toward evidence-based severity assessment in rat models with repeated seizures: I. Electrical kindling

Epilepsia ◽  
2018 ◽  
Vol 59 (4) ◽  
pp. 765-777 ◽  
Author(s):  
Christina Möller ◽  
Fabio Wolf ◽  
R. Maarten van Dijk ◽  
Valentina Di Liberto ◽  
Vera Russmann ◽  
...  
Keyword(s):  
Evidence Based ◽  
Severity Assessment ◽  
Rat Models ◽  
Electrical Kindling

scholarly journals The Treatment and Prognosis of Refractory and Super-Refractory Status Epilepticus

2017 ◽  
Vol 01 (03) ◽  
pp. E204-E210
Author(s):  
Stephanie Gollwitzer ◽  
Hajo Hamer
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Case Reports ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Evidence Based ◽  
New Approach ◽  
Refractory Status ◽  
First Choice ◽  
Evidence Based Guidelines

AbstractRefractory status epilepticus (RSE) is defined as status epilepticus (SE) persisting over 60 min and resistant to treatment with benzodiazepines and non-sedating antiepileptic drugs. The term super-refractory status epilepticus (SRSE) refers to a refractory episode continuing under general anesthesia for more than 24 h. RSE is treated with a combination of non-sedating AED and i. v. anesthetics; first choice drugs are midazolam, propofol and thiopental. The management of super-refractory status epilepticus (SRSE) is challenging as clear evidence-based guidelines are lacking. Recommendations are mainly based on case reports and small case series. Therapeutic options include ketamine, inhalational anesthetics, steroids and immunoglobulins. Ketogenic diet, electroconvulsive therapy and epilepsy surgery are also considered as potentially effective. A promising new approach is the neurosteroid allopregnanolone. Mortality of RSE and SRSE is largely influenced by the etiology and is markedly higher as compared to non-refractory status epilepticus. It was reported to be about 30% and 50%, respectively.

scholarly journals Status Epilepticus: The Slow and Agonizing Death of Phenytoin

2020 ◽  
Vol 25 (1) ◽  
pp. 4-6 ◽  
Author(s):  
Elizabeth A. Hall ◽  
James W. Wheless ◽  
Stephanie J. Phelps
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Drug Interactions ◽  
Mechanism Of Action ◽  
Adult Patients ◽  
Evidence Based ◽  
Insufficient Evidence ◽  
First Line ◽  
Acute Seizures ◽  
Acute Seizure

Since its introduction in 1950, phenytoin (PHT) has been the premier parenteral anticonvulsant used in the management of generalized convulsive status epileptics (GCSE) that is refractory to benzodiazepines. Without question, its arrival was vital to the care of patients with acute seizures and was a welcomed alternative to paraldehyde and phenobarbital. However, after more than half a century of use, there continues to be insufficient evidence-based data to support its efficacy over other anticonvulsants as a first-line agent in pediatric or adult patients with GCSE. This coupled with its narrow mechanism of action, complex pharmacokinetics and pharmacogenomics, drug-drug interactions, unique adverse effects, and formulation issues that make administration difficult mandates that PHT be replaced by safer and superiorly effective anticonvulsants for the treatment of GCSE when benzodiazepines are ineffective. We believe that levetiracetam should become the preferred agent for seizures unresponsive to or recurring after treatment with a benzodiazepine as it is at least equally effective to PHT and has several important advantages. PHT has overstayed its welcome and it is simply time for it to exit the realm of acute seizure management as a first-line agent for benzodiazepine-refractory GCSE.

Where are we heading? Challenges in evidence-based severity assessment

2019 ◽  
Vol 54 (1) ◽  
pp. 50-62 ◽  
Author(s):  
Lydia M Keubler ◽  
Nils Hoppe ◽  
Heidrun Potschka ◽  
Steven R Talbot ◽  
Brigitte Vollmar ◽  
...  
Keyword(s):  
Study Design ◽  
Animal Experiments ◽  
Laboratory Animals ◽  
Ethical Responsibility ◽  
Evidence Based ◽  
Severity Assessment ◽  
Valid Data ◽  
Holistic Concept ◽  
Pain Distress

Evidence-based severity assessment in laboratory animals is, apart from the ethical responsibility, imperative to generate reproducible, standardized and valid data. However, the path towards a valid study design determining the degree of pain, distress and suffering experienced by the animal is lined with pitfalls and obstacles as we will elucidate in this review. Furthermore, we will ponder on the genesis of a holistic concept relying on multifactorial composite scales. These have to combine robust and reliable parameters to measure the multidimensional aspects that define the severity of animal experiments, generating a basis for the substantiation of the refinement principle.

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