scholarly journals Refractory status epilepticus in children with and without prior epilepsy or status epilepticus

Neurology ◽  
2016 ◽  
Vol 88 (4) ◽  
pp. 386-394 ◽  
Author(s):  
Iván Sánchez Fernández ◽  
Michele C. Jackson ◽  
Nicholas S. Abend ◽  
Ravindra Arya ◽  
James N. Brenton ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Similar Time ◽  
Refractory Status ◽  
History Of ◽  
To Receive ◽  
Observational Descriptive Study ◽  
Timely Administration ◽  
Timely Treatment

Objective:To compare refractory convulsive status epilepticus (rSE) management and outcome in children with and without a prior diagnosis of epilepsy and with and without a history of status epilepticus (SE).Methods:This was a prospective observational descriptive study performed from June 2011 to May 2016 on pediatric patients (1 month–21 years of age) with rSE.Results:We enrolled 189 participants (53% male) with a median (25th–75th percentile) age of 4.2 (1.3–9.6) years. Eighty-nine (47%) patients had a prior diagnosis of epilepsy. Thirty-four (18%) patients had a history of SE. The time to the first benzodiazepine was similar in participants with and without a diagnosis of epilepsy (15 [5–60] vs 16.5 [5–42.75] minutes, p = 0.858). Patients with a diagnosis of epilepsy received their first non-benzodiazepine (BZD) antiepileptic drug (AED) later (93 [46–190] vs 50.5 [28–116] minutes, p = 0.002) and were less likely to receive at least one continuous infusion (35/89 [39.3%] vs 57/100 [57%], p = 0.03). Compared to patients with no history of SE, patients with a history of SE received their first BZD earlier (8 [3.5–22.3] vs 20 [5–60] minutes, p = 0.0073), although they had a similar time to first non-BZD AED (76.5 [45.3–124] vs 65 [32.5–156] minutes, p = 0.749). Differences were mostly driven by the patients with an out-of-hospital rSE onset.Conclusions:Our study establishes that children with rSE do not receive more timely treatment if they have a prior diagnosis of epilepsy; however, a history of SE is associated with more timely administration of abortive medication.

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

scholarly journals Vagus Nerve Stimulation (VNS) in Super Refractory New Onset Refractory Status Epilepticus (NORSE)

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Mohankumar Kurukumbi ◽  
James Leiphart ◽  
Anam Asif ◽  
Jing Wang
Keyword(s):  
Status Epilepticus ◽  
Vagus Nerve ◽  
Nerve Stimulation ◽  
Vagus Nerve Stimulation ◽  
Refractory Epilepsy ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
History Of ◽  
Electrographic Seizures ◽  
New Onset

The treatment protocol of status epilepticus has many associated toxicities so there is interest in alternate nonmedicinal therapies for managing New Onset Refractory Status Epilepticus (NORSE) patients. Vagus nerve stimulation (VNS) is an FDA-approved therapy for refractory epilepsy that has been shown to decrease the frequency and severity of seizures. We present the case of a patient with new-onset refractory status epilepticus (NORSE) whose seizures were successfully treated with vagus nerve stimulation. A 25-year-old male with no history of epilepsy or other neurological disorders presented with altered mental status and generalized tonic-clonic seizures following a two-week history of an upper respiratory tract infection. Lumbar puncture showed neutrophilic pleocytosis, and he was treated for bacterial and viral meningoencephalitis. In spite of treatment, his seizures began increasing in frequency. On day three, the patient entered status epilepticus (SE) refractory to intensive pharmacotherapy with maximal doses of valproate, levetiracetam, and propofol. On day four, SE remained refractory, so pentobarbital was introduced with targeted burst suppression pattern on electroencephalography (EEG). Patient continued to be refractory to these measures, so a vagus nerve stimulator (VNS) was implanted (day eight). Following VNS implantation, EEG demonstrated significant reduction of seizure activity and subsequent magnet swiping continued aborting electrographic seizures. No SE or electrographic seizures were reported for seventy-two hours, but few occasional discharges were reported. Seizures eventually recurred on day fourteen and the patient succumbed to his multiple comorbidities on day seventeen. Due to the efficacy of VNS in refractory epilepsy, there was interest in using it in refractory status epilepticus. Multiple case reports have described a benefit from implantation of VNS in the treatment of SE. The successful use of VNS to acutely terminate status epilepticus for seventy-two hours in this critically ill patient adds to current evidence that there is utility in using VNS for refractory status epilepticus.

scholarly journals Enteral Topiramate in a Pediatric Patient with Refractory Status Epilepticus: A Case Report and Review of the Literature

2014 ◽  
Vol 19 (4) ◽  
pp. 317-324
Author(s):  
Chasity M. Shelton ◽  
Elizabeth L. Alford ◽  
Stephanie Storgion ◽  
James Wheless ◽  
Stephanie J. Phelps
Keyword(s):  
Case Report ◽  
Metabolic Acidosis ◽  
Status Epilepticus ◽  
Pediatric Patient ◽  
Treatment Option ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Review Of The Literature ◽  
Refractory Status

We describe the use of topiramate in a healthy 12-year-old (88-kg) male who developed refractory generalized convulsive status epilepticus. Seizures persisted despite aggressive use of benzodiazepines (intravenous lorazepam; oral clorazepate), barbiturates (i.e., phenobarbital, pentobarbital), and hydantoins. The child's seizures were controlled with nasogastrically administered topiramate in doses up to 500 mg twice daily (11.4 mg/kg/day). The patient did not display any clinical or laboratory signs of metabolic acidosis while receiving topiramate. Topiramate should be considered as a treatment option in refractory status epilepticus.

Antiepileptic Drugs

2018 ◽  
Author(s):  
Eelco F. M. Wijdicks ◽  
Sarah L. Clark
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Status Epilepticus ◽  
Antiepileptic Drugs ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Refractory Status ◽  
Focal Status Epilepticus

Patients are often admitted to the neurosciences intensive care unit specifically for the treatment of a series of seizures or focal status epilepticus. Far more urgent is convulsive status epilepticus, which requires multiple intravenously administered antiepileptic drugs. The choices are different when the patient is in status epilepticus and refractoriness is mostly due to pharmacologic resistance. Use of an algorithm for decision making is common in the management of refractory status epilepticus. Antiepileptic drugs often interact with other antiepileptic drugs. This chapter discusses the use of antiepileptic drugs available to treat seizures, recurrent seizures, status epilepticus, and refractory status epilepticus.

scholarly journals Unusual cause of fever, vision loss and super refractory status epilepticus in association with simian virus 40 (SV40)

2018 ◽  
pp. bcr-2018-225539
Author(s):  
Ayush Agarwal ◽  
Deepti Vibha ◽  
Rohan Chawla ◽  
Mehar Chand Sharma
Keyword(s):  
Status Epilepticus ◽  
Vision Loss ◽  
Simian Virus 40 ◽  
Brain Biopsy ◽  
Refractory Status Epilepticus ◽  
Simian Virus ◽  
Anaesthetic Agents ◽  
Refractory Status ◽  
History Of ◽  
Conclusive Diagnosis

We present a case of a 23-year-old man with history of fever followed by painless complete vision loss, with subsequent new-onset refractory status epilepticus (NORSE). He initially developed bilateral retinitis. A few days later, he started having focal seizures, and subsequently developed super-refractory status epilepticus, requiring anaesthetic agents. MRI brain revealed multifocal cortical and subcortical hyperintensities in occipital and temporoparietal regions without contrast enhancement. MRI repeated a month later showed new lesions with non-visualisation of some previous lesions. Finally, a brain biopsy was done which revealed presence of lymphocytic infiltrate with SV40 inclusions in oligodendrocyte. We propose the affliction of an atypical virus affecting the retina and brain grey and white matter, presenting with NORSE in our patient. Future similar cases and isolation of the virus may help in establishing the conclusive diagnosis.

scholarly journals New Onset Refractory Status Epilepticus as an Unusual Presentation of a Suspected Organophosphate Poisoning

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shahan Waheed ◽  
Amber Sabeen ◽  
Nadeem Ullah Khan
Keyword(s):  
Status Epilepticus ◽  
Intravenous Infusion ◽  
Refractory Status Epilepticus ◽  
Young Female ◽  
University Hospital ◽  
Organophosphate Poisoning ◽  
Anesthetic Agents ◽  
Refractory Status ◽  
History Of ◽  
New Onset

New onset refractory status epilepticus (NORSE) is a new entity in medical literature. It has different infectious and noninfectious etiologies showing a devastating impact onto the clinical outcome of patients. Therapy with anaesthetic and antiepileptic agents often fails to improve the condition, unless the primary cause is rectified. Here is presented the case of a young female with a history of depression who after a recent bereavement came to the Emergency Department of Aga Khan University Hospital with complaints of drowsiness that lasted for few hours. Though she had no history of organophosphate poisoning, her physical examination and further investigations were suggestive of the diagnosis. During her hospital stay, she developed refractory status epilepticus. Her seizures did not respond to standard antiepileptic and intravenous anesthetic agents and subsided only after intravenous infusion of atropine for a few days. Organophosphate poisoning is a very common presentation in the developing world and the associated status epilepticus poses a devastating problem for emergency physicians. In patients with suspected organophosphate poisoning with favoring clinical exam findings, the continuation of atropine intravenous infusion can be a safe option to abate seizures.

scholarly journals Management of super refractory status epilepticus

2020 ◽  
Author(s):  
Dedy Kurniawan ◽  
Abdulloh Machin ◽  
Hanik Badriyah Hidayati ◽  
Wardah Rahmatul Islamiyah
Keyword(s):  
Status Epilepticus ◽  
Continuous Monitoring ◽  
Refractory Status Epilepticus ◽  
Clinical Judgement ◽  
Convulsive Status Epilepticus ◽  
Electrographic Seizure ◽  
Aggressive Therapy ◽  
Refractory Status ◽  
The Status ◽  
Prolonged Recovery

Super refractory status epilepticus ( SRSE ) is the status epilepticus in which the seizures continue for 24 hour or more after anesthetic medications to control and reappear when the patient is weaned from the anesthetic agent. Characteristic seizures are distinguished, by the presence and/or absence of motor seizure, into convulsive and non-convulsive status epilepticus (NCSE). An aggressive therapy is often needed after diagnosis is confirmed. Continuous monitoring during therapy is very important. The management for SRSE includes pharmacological and non-pharmacological treatment. Clinical and electrographic seizure suppression is the treatment goal. After that we need to find and treat the cause of seizures. Clinical judgement by the clinician is needed to identify the risks of excessive suppression of the nervous system, so as the morbidity and mortality is reduced for those patients who can survive but often have difficult and prolonged recovery. Received: 24 Oct 2018Reviewed: 28 Oct 2018Accepted: 6 Nov 2018 Citation: Kurniawan D, Machin A, Hidayati HB, Islamiyah WR. Management of super refractory status epilepticus. Anaesth Pain & Intensiv Care 2018;22 Suppl 1:S67-S72

scholarly journals Autoimmune Encephalitis: An Unusual Presentation as Nonconvulsive Status Epilepticus

2019 ◽  
Vol 7 (01) ◽  
pp. 41-43
Author(s):  
Deepak Solanki ◽  
Saurabh Anand
Keyword(s):  
Status Epilepticus ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Clinical Findings ◽  
Acute Onset ◽  
Prior History ◽  
Laboratory Findings ◽  
Epileptiform Discharges ◽  
Refractory Status ◽  
History Of

AbstractWhen refractory status epilepticus (RSE) occurs in an individual without any history of epilepsy and no immediate underlying etiology is found, it is referred to as new-onset refractory status epilepticus (NORSE). This clinical scenario may be notoriously difficult to treat and does not respond to initial medications. In cases of NORSE in which an etiology is found, antibody-mediated disorders are the most common cause. Autoimmune encephalitis refers to a diverse group of neuropsychiatric disorders and can present with an array of symptoms many of which make diagnosis difficult due to similarities in clinical, imaging, and laboratory findings with respect to other forms of autoimmune or infectious encephalitis. This case report highlights how a patient with acute-onset history, showing generalized periodic epileptiform discharges on electroencephalogram (EEG) but with no prior history of seizures, was eventually diagnosed as autoimmune encephalitis based on clinical findings, cerebrospinal fluid (CSF) reports, and EEG analysis.

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