Intravenous brivaracetam for the management of refractory focal non-convulsive status epilepticus

2020 ◽  
Vol 13 (11) ◽  
pp. e234955
Author(s):  
Abdalla A Ammar ◽  
Mahmoud A Ammar ◽  
Kent Owusu ◽  
Emily J Gilmore
Keyword(s):  
Status Epilepticus ◽  
Synaptic Vesicle ◽  
Convulsive Status Epilepticus ◽  
Limited Data ◽  
Patient Case ◽  
Diagnosis And Management ◽  
Continuous Electroencephalography

Diagnosis and management of status epilepticus (SE), including non-convulsive status epilepticus (NCSE), is challenging, with a reported 30%–50% of epilepticus patients not responding to available antiseizure medications (ASMs). Injectable benzodiazepines, fosphenytoin, valproate, levetiracetam, lacosamide and phenobarbital are commonly used for treating SE. Brivaracetam, a new ASM, with higher affinity and greater selectivity for the synaptic vesicle glycoprotein 2A than levetiracetam, has been approved as monotherapy or adjunct for treatment of focal onset seizures. Brivaracetam may have a role in the management of SE. However, limited data exist on brivaracetam’s efficacy in SE. We describe a patient case with focal NCSE refractory to levetiracetam, fosphenytoin, lacosamide and valproate who demonstrated clinical and electrographic improvement on continuous electroencephalography monitoring after brivaracetam administration.

scholarly journals Convulsive status epilepticus in children in Mozambique: Is there a treatment gap?

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Jo Marie. B. Sourbron ◽  
Lieven Lagae ◽  
Dalila Ibrahimo Sulemane
Keyword(s):  
Status Epilepticus ◽  
Developed Countries ◽  
Convulsive Status Epilepticus ◽  
Second Line ◽  
Limited Data ◽  
Optimal Care ◽  
Resource Limited ◽  
Prehospital Management ◽  
Significant Difference ◽  
Line Drug

Background: Optimal care of Convulsive status epilepticus (CSE) can be related to multiple barriers in resource-limited countries. Objectives and methods: Since limited data of CSE management are available from South-East Africa, we performed a retrospective analysis of the electronic records of pediatric patients with CSE admitted to the Maputo Central hospital from January 2016 until April 2019. Results: Our database consisted out of 39 patients. The average age was 5.15 (range 0.3-13.8) years and demographic characteristics did not show a relation to CSE characteristics or outcomes. However, the total stay in the hospital was negatively correlated with age (p=0.0314). Moreover, 14 patients needed to be admitted to the IC, which was correlated to having generalized motor seizures (p=0.0253), and a relatively higher need for a second AED to control their CSE (p=0.0131). Regarding AED use, the first AED was a IV benzodiazepine (BZD: midazolam (MIDA) or diazepam (DIAZ)) or IV phenytoin (PHEN) when BZDs were not available. There was no statistically significant difference between the efficacy of MIDA vs. DIAZ. Eleven patients received PHEN as a second-line drug, of which only two patients needed an additional dose of PHEN. None of the patients died and five patients (13.2%) had an extra comorbidity after CSE. Conclusions: Although limited AEDs were available in our study, compared to more AEDs in other developing and developed countries, we report the successful cessation of CSE in the majority of cases. We recommend strategies to improve prehospital management such as the use of non-IV BZD use, to limit the need for patients to be admitted to the IC and thereby potentially decreasing the number of AEDs, morbidity and hospital duration. Moreover, our data underline the conversion to second-line AEDs (PHEN) to be adequate in nearly all patients.

scholarly journals Non-convulsive status epilepticus: COVID-19 or clozapine induced?

2020 ◽  
Vol 13 (10) ◽  
pp. e239015 ◽  
Author(s):  
Elisaveta Sokolov ◽  
Shahrzad Hadavi ◽  
Laura Mantoan Ritter ◽  
Franz Brunnhuber
Keyword(s):  
Differential Diagnosis ◽  
Status Epilepticus ◽  
Schizoaffective Disorder ◽  
Convulsive Status Epilepticus ◽  
Neurological Manifestations ◽  
Diagnosis And Management ◽  
Global Pandemic ◽  
Antiepileptic Medication ◽  
Eeg Changes ◽  
Electroencephalogram Eeg

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.

scholarly journals Emergency management of the paediatric patient with convulsive status epilepticus

2021 ◽  
Vol 26 (1) ◽  
pp. 50-57
Author(s):  
Kyle C McKenzie ◽  
Cecil D Hahn ◽  
Jeremy N Friedman
Keyword(s):  
Clinical Practice ◽  
Status Epilepticus ◽  
Emergency Management ◽  
Treatment Algorithm ◽  
Position Statement ◽  
Convulsive Status Epilepticus ◽  
Pharmacological Management ◽  
The Past ◽  
New Treatment ◽  
New Evidence

Abstract This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.

Salzburg Criteria, A Useful Tool in Non-Convulsive Status Epilepticus Diagnosis: A Retrospective Study

2021 ◽  
pp. 155005942199171
Author(s):  
Adriana Gómez Domínguez ◽  
Raidili C. Mateo Montero ◽  
Alba Díaz Cid ◽  
Antonio J. P. Mazarro ◽  
Ignacio R. Bailly-Bailliere ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Status Epilepticus ◽  
Prospective Studies ◽  
Correct Diagnosis ◽  
Original Description ◽  
Neurological Deficits ◽  
Convulsive Status Epilepticus ◽  
Poor Outcome

Introduction. Non-convulsive status epilepticus (NCSE) has been traditionally a challenging electroencephalographic (EEG) diagnosis. For this reason, Salzburg consensus criteria (SCC) have been proposed to facilitate correct diagnosis. Methods. We retrospectively reanalyzed 41 cases referred to our department (from 2016 to 2018) under the suspicion of NCSE. In this study, we compared the original description (standard criteria) versus the updated description (SCC) of the same EEG. Results. Originally, 15 patients were diagnosed as NCSE (37%) and 26 patients as no NCSE (63%), using the standard criteria. Then, we analyzed EEGs according to the SCC, which led to the following results: 9 patients fulfilled the criteria for definite NCSE (22%), 20 patients were diagnosed as possible NCSE (49%) and 12 patients were diagnosed as no NCSE (29%). Subsequently, when we analyze the outcome of possible NCSE cases, we note that 50% of these patients presented mild-poor outcome (neurological deficits, deceased). Indeed, we observed worse outcomes in patients previously diagnosed as no NCSE and untreated, specifically post-anoxic cases. Conclusions. Salzburg criteria seem to be a useful tool to support NCSE diagnosis, introducing the category of possible NCSE. In our study, we observed that it contributes to improving the prognosis and management of the patients. However, more prospective studies are needed to demonstrate the accuracy of SCC.

Not all patients with convulsive status epilepticus intubated in pre-hospital settings meet the criteria for refractory status epilepticus

Seizure ◽  
2021 ◽  
Vol 88 ◽  
pp. 29-35
Author(s):  
Sinead Zeidan ◽  
Benjamin Rohaut ◽  
Hervé Outin ◽  
Francis Bolgert ◽  
Marion Houot ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Refractory Status

Non-convulsive status epilepticus induced by acute thalamic lesions: a report of three cases

Seizure ◽  
2021 ◽  
Author(s):  
Sara Parreira ◽  
Luís Abreu ◽  
Ana Franco ◽  
Carla Bentes ◽  
Ana Rita Peralta
Keyword(s):  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Thalamic Lesions

scholarly journals Prevalence and factors associated with convulsive status epilepticus in Africans with epilepsy

Neurology ◽  
2015 ◽  
Vol 84 (18) ◽  
pp. 1838-1845 ◽  
Author(s):  
S. M. Kariuki ◽  
A. Kakooza-Mwesige ◽  
R. G. Wagner ◽  
E. Chengo ◽  
S. White ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Factors Associated
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