scholarly journals Oral Perampanel for the Treatment of Super-Refractory Status Epilepticus

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Abdallah Rahbani ◽  
Grace Adwane ◽  
Najo Jomaa
Keyword(s):  
Valproic Acid ◽  
Status Epilepticus ◽  
Clinical Outcome ◽  
Nasogastric Tube ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
Partial Status Epilepticus ◽  
High Doses ◽  
Excellent Clinical Outcome ◽  
Partial Status

A 72-year-old man presented with a super-refractory partial status epilepticus following evacuation of a right subdural hematoma. He failed to respond to treatment with high doses of intravenous valproic acid, Levetiracetam, Lacosamide, Thiopental, and Midazolam. He was given 4 mg of Perampanel orally via nasogastric tube and the dose was rapidly increased to 8 mg after 12 hours with cessation of clinical and electrical seizures. Other antiepileptic drugs were tapered progressively with an excellent clinical outcome.

scholarly journals Management of Status Epilepticus

2019 ◽  
Vol 06 (03) ◽  
pp. 267-274
Author(s):  
Ritesh Lamsal ◽  
Navindra R. Bista
Keyword(s):  
Status Epilepticus ◽  
High Risk ◽  
Critically Ill Patients ◽  
Initial Treatment ◽  
Refractory Status Epilepticus ◽  
The Past ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
Life Threatening ◽  
High Doses

AbstractStatus epilepticus (SE) is a life-threatening neurologic condition that requires immediate assessment and intervention. Over the past few decades, the duration of seizure required to define status epilepticus has shortened, reflecting the need to start therapy without the slightest delay. The focus of this review is on the management of convulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment of both forms of status epilepticus includes immediate assessment and stabilization, and administration of rapidly acting benzodiazepine therapy followed by nonbenzodiazepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and SRSE) pose a lot of therapeutic problems, necessitating the administration of continuous infusion of high doses of anesthetic agents, and carry a high risk of debilitating morbidity as well as mortality.

scholarly journals Changes in lipids and inflammation in adults with super-refractory status epilepticus on a ketogenic diet

2021 ◽  
Author(s):  
Alex M Dickens ◽  
Tory Johnson ◽  
Santosh Lamichhane ◽  
Jacqueline Lovett ◽  
Anupama Kumar ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Clinical Outcome ◽  
Ketogenic Diet ◽  
Inflammatory Cytokines ◽  
Ketone Body ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
Clinical Measurements ◽  
Body Production ◽  
Pro Inflammatory Cytokines

AbstractObjectiveTo test the hypothesis that increased ketone body production with a ketogenic diet (KD) will correlate with reductions in pro-inflammatory cytokines, lipid subspecies, and improved clinical outcomes in adults treated with an adjunctive ketogenic diet for super-refractory status epilepticus (SRSE).MethodsAdults (18 years or older) were treated with a 4:1 (fat:carbohydrate and protein) ratio enteral KD as adjunctive therapy to pharmacologic seizure suppression for SRSE. Blood and urine samples and clinical measurements were collected at baseline (n=10), after 1 week (n=8), and after 2 weeks of KD (n=5). Urine acetoacetate, serum β-hydroxybutyrate, lipidomics, pro-inflammatory cytokines (IL-1β, IL-6), chemokines (CCL3, CCL4, CXCL13), and clinical measurements were obtained at these 3 time points. Univariate and multivariate data analyses were performed to determine the correlation between ketone body production and circulating lipids, inflammatory biomarkers, and clinical outcome.ResultsChanges in lipids included an increase in ceramides, mono-hexosyl ceramide, sphingomyelin, phosphocholine, and phosphoserines, and there was a significant reduction in IL-6 and CXCL13 seen at 1 and 2 weeks of KD. Higher blood β-hydroxybutyrate levels at baseline correlated with better clinical outcome however, ketone body production did not correlate with other variables during treatment. Higher pro-inflammatory chemokine CCL3 levels following treatment correlated with greater length of intensive care unit stay, higher modified Rankin Scale score (worse neurologic disability) at discharge and 6-month follow up.ConclusionsAdults receiving an adjunctive enteral ketogenic diet for super-refractory status epilepticus have alterations in select pro-inflammatory cytokines and lipid species that may predict response to treatment.

scholarly journals New-Onset Refractory Status Epilepticus: More Investigations, More Questions

2016 ◽  
Vol 8 (2) ◽  
pp. 127-133 ◽  
Author(s):  
Philippe Dillien ◽  
Susana Ferrao Santos ◽  
Vincent van Pesch ◽  
Vanessa Suin ◽  
Sophie Lamoral ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Immune Therapy ◽  
Healthy Woman ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
The Status ◽  
Third Line Therapy ◽  
High Doses ◽  
Third Line ◽  
New Onset

A 27-year-old previously healthy woman was admitted to the hospital with recurrent seizures. Status epilepticus developed that became refractory to third-line therapy with propofol and barbiturates. The patient had a very extensive diagnostic workup including autoimmune, viral and genetic investigations. A tentative immune therapy was proposed with high doses of steroids and plasma exchanges. Our patient had an inherited heterozygous single nucleotide variant in the sequence c.1280A>G [p.Lys427Arg] of the SMC3 gene that was insufficient to explain the seizures. Surprisingly, IgM antibodies against Japanese encephalitis virus were positive on the serum drawn 11 days after symptom onset, as detected by ELISA and the immunofluorescence antibody (IFA) technique. IgG antibodies were also positive using the IFA technique, but not with ELISA. The same investigations as well as the detection of the viral genome by the q-RT-PCR technique were negative on cerebrospinal fluid. Despite the suspicion of a viral infection, we concluded that our patient had a new-onset refractory status epilepticus of cryptogenic origin. Termination of the status epilepticus was obtained after 47 days, with a possible benefit from the introduction of ketamine.

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

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