Lacosamide for the Treatment of Refractory Status Epilepticus

2011 ◽  
Vol 45 (11) ◽  
pp. 1445-1449 ◽  
Author(s):  
Erica M Fernandez ◽  
Andrew J Franck
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Current Evidence ◽  
Refractory Status ◽  
Successful Termination ◽  
Study Selection ◽  
Animal Data

Objective: To evaluate current evidence for the use of lacosamide in the treatment of refractory status epilepticus. Data Sources: Literature was accessed via PubMed (through July 2011) using the terms lacosamide and status epilepticus. Study Selection and Data Extraction: All reports on the use of lacosamide in patients with status epilepticus were included for evaluation. Reviews and animal data were excluded. Data Synthesis: Treatment of status epilepticus is challenging, and most patients fail to respond to initial treatment. Recently, several reports have been published on the use of lacosamide for status epilepticus. Eleven reports (5 case reports and 6 case series) were identified. Lacosamide was credited with successful termination of status epilepticus in a majority of these reports, However, the data are weakened by the heterogeneity of the reports, their descriptive nature, and the common divergence from current recommendations for the treatment of status epilepticus, Conclusions: While lacosamide has been reported as an effective treatment for refractory status epilepticus, there is insufficient evidence for its routine use. For cases in which the risks associated with anesthetizing drugs are believed to outweigh the benefits, such as in complex partial status epilepticus, lacosamide may be a reasonable option after more established drug therapies fail.

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 New-onset super refractory status epilepticus: A case-series

Seizure ◽  
2020 ◽  
Vol 75 ◽  
pp. 174-184 ◽  
Author(s):  
Sidra Aurangzeb ◽  
Lara Prisco ◽  
Jane Adcock ◽  
Mahiri Speirs ◽  
Simon Raby ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Refractory Status ◽  
New Onset

Drug-Induced Restless Legs Syndrome

2018 ◽  
Vol 52 (7) ◽  
pp. 662-672 ◽  
Author(s):  
Edna Patatanian ◽  
Melanie K. Claborn
Keyword(s):  
Restless Legs Syndrome ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Predisposing Factors ◽  
Drug Induced ◽  
Restless Legs ◽  
Drug Classes ◽  
Study Selection

Objective: To review the literature on drug-induced restless legs syndrome (DI-RLS). Data Sources: The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. Results: Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. Conclusions: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

scholarly journals Ketogenic diet for super-refractory status epilepticus: A case series and review of literature

2021 ◽  
Vol 0 (0) ◽  
pp. 0
Author(s):  
VimalKumar Paliwal ◽  
Sucharita Anand ◽  
AmarS Vibhute ◽  
Ananya Das ◽  
Shilpi Pandey
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Review Of Literature ◽  
Refractory Status

scholarly journals Electroconvulsive Therapy in Super Refractory Status Epilepticus: Case Series with a Defined Protocol

2020 ◽  
Vol 17 (11) ◽  
pp. 4023
Author(s):  
Beatriz García-López ◽  
Ana Isabel Gómez-Menéndez ◽  
Fernando Vázquez-Sánchez ◽  
Eva Pérez-Cabo ◽  
Francisco Isidro-Mesas ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Adverse Effects ◽  
Electroconvulsive Therapy ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
High Morbidity ◽  
General Anesthetics ◽  
Antiepileptic Treatment ◽  
Refractory Status ◽  
Feasible Option

Super-refractory status epilepticus (SRSE) represents a neurological emergency that is characterized by a lack of response to the third line of antiepileptic treatment, including intravenous general anesthetics. It is a medical challenge with high morbidity and mortality. Electroconvulsive therapy (ECT) has been recommended as a nonpharmacologic option of treatment after other alternatives are unsuccessful. Its effect on the cessation of SRSE has been minimally investigated. The objective of this article is to analyze the effect of ECT on SRSE. For this purpose, a multidisciplinary team created a protocol based on clinical guidelines similar to those described previously by Ray et al. (2017). ECT was applied to six patients with SRSE after the failure of antiepileptic treatment and pharmacologic coma.The objective of each ECT session was to elicit a motor seizure for at least 20 s. SRSE was resolved in all patients after several days of treatment, including ECT as a therapy, without relevant adverse effects. Thus, ECT is an effective and feasible option in the treatment of SRSE, and its place in the algorithm in treatment should be studied due to the uncommon adverse effects and the noninvasive character of the therapy.

Insect Repellent (N,N-Diethyl-m-Toluamide) Cardiovascular Toxicity in an Adult

1993 ◽  
Vol 27 (3) ◽  
pp. 289-293 ◽  
Author(s):  
James R. Clem ◽  
David F. Havemann ◽  
Marsha A. Raebel
Keyword(s):  
Medical Literature ◽  
Case Reports ◽  
Data Extraction ◽  
Clinical Manifestations ◽  
Personal Contact ◽  
Cardiovascular Toxicity ◽  
Insect Repellents ◽  
Literature Searches ◽  
Study Selection ◽  
Animal Data

OBJECTIVE: To describe a case of N,N-diethyl- m-toluamide (DEET)-induced cardiovascular toxicity in an adult and reviews other cases that have been reported in the published literature. Human and animal data available on DEET pharmacokinetics are reviewed and factors that predispose an individual to DEET toxicity are identified. DATA SOURCES: Case report information was obtained through personal contact with the patient during hospitalization and by telephone, and also from the patient's medical records. Computerized literature searches were conducted with the following systems to obtain medical literature on DEET toxicity: TOXLINE, International Pharmaceutical Abstracts, and MEDLINE. Index Medicus was searched manually. STUDY SELECTION: All reported cases of DEET toxicity in children and adults were reviewed. DATA EXTRACTION: Case reports were evaluated for the quantity of the DEET exposure (topical or oral), the clinical manifestations of the exposure, and the outcome of the exposure. DATA SYNTHESIS: This case is similar in some aspects to those already in the literature; however, very few cases of DEET toxicity in adults have been reported. Cardiovascular toxicity in humans related to DEET application has not been previously reported in the published medical literature. DEET exposure (topical or oral) results in a highly variable clinical course. Whether the outcome is death or recovery without sequelae is difficult to predict. CONCLUSIONS: Adults, as well as children, are at risk for toxicity from insect repellents. The use of highly concentrated DEET-containing insect repellents should be avoided to reduce the risk of toxicity in both children and adults. The consequences of DEET toxicity are variable and unpredictable.

scholarly journals Emergency Management of Paraphimosis

2003 ◽  
Vol 10 (4) ◽  
pp. 253-257 ◽  
Author(s):  
Ch Chung
Keyword(s):  
Case Reports ◽  
Data Extraction ◽  
Treatment Options ◽  
Case Series ◽  
Treatment Modalities ◽  
Invasive Treatment ◽  
Manual Search ◽  
Study Selection ◽  
Library Network ◽  
Randomised Controlled

Objective To review the treatment modalities available for paraphimosis, with special emphasis on those applicable to the emergency department. Data source Relevant medical literature was searched through MEDLINE, EMBASE, CINAHL, and Cochrane Database. Manual search was performed in books on Urology, General Surgery and Emergency Medicine available in the Hospital Library. Further information was obtained through the Internet at < www.infoseek.com >. References cited in articles were also retrieved. Study selection Key words for the literature, Internet and textbook search were ‘paraphimosis’ and ‘treatment’. All available years of study were reviewed. Data extraction Relevant full text articles were obtained through the hospital library network. Original articles, review papers, medical practice, case reports, and relevant book chapters were reviewed. Data synthesis There were no prospective, randomised, controlled studies available. The majority were case series and expert experience or opinions only. Currently, a multitude of non-invasive and invasive treatment options are available, including manual reduction, help of non-crushing tissue forceps, puncture technique and dorsal slit. Conclusion All treatment methods are within the capability of the emergency physician. Hospitalization should rarely be required, unless there are serious complications.

scholarly journals Super-Refractory Status Epilepticus Treated with High Dose Perampanel: Case Series and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Christopher R. Newey ◽  
Naresh Mullaguri ◽  
Stephen Hantus ◽  
Vineet Punia ◽  
Pravin George
Keyword(s):  
Cardiac Arrest ◽  
Status Epilepticus ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Critically Ill Patient ◽  
Unknown Etiology ◽  
High Dose ◽  
The Novel ◽  
Refractory Status ◽  
Symptomatic Seizures

Introduction. Acute symptomatic seizures are frequent in the critically ill patient and can be difficult to treat. The novel anticonvulsant perampanel may be effective in the treatment of status epilepticus considering its mechanism of action of being an AMPA antagonist. We present four cases of super refractory status epilepticus treated with high dose perampanel. Method. Case report. Cases. Four patients were treated with perampanel for their refractory status epilepticus. One patient had new onset refractory status epilepticus of unknown etiology. Three other patients had status epilepticus as a result of their cardiac arrest. Two of the cardiac arrest patients had myoclonus. In all patients, the additional of perampanel resulted in a reduction of seizure burden without affecting hemodynamics or hepatic or renal function. Conclusion. Perampanel may be effective in the treatment of super-refractory status epilepticus of varying etiologies. A larger, prospective study is needed to further assess this therapy.

scholarly journals New-onset super-refractory status epilepticus

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2280-e2285 ◽  
Author(s):  
Elizabeth Matthews ◽  
Ayham Alkhachroum ◽  
Nina Massad ◽  
Riva Letchinger ◽  
Kevin Doyle ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Medical Center ◽  
Case Series ◽  
Refractory Status Epilepticus ◽  
Hospital Length Of Stay ◽  
Post Discharge ◽  
Refractory Status ◽  
New Onset

ObjectiveTo better understand the heterogeneous population of patients with new-onset refractory status epilepticus (NORSE), we studied the most severe cases in patients who presented with new-onset super-refractory status epilepticus (NOSRSE).MethodsWe report a retrospective case series of 26 adults admitted to the Columbia University Irving Medical Center neurologic intensive care unit (NICU) from February 2009 to February 2016 with NOSRSE. We evaluated demographics, diagnostic studies, and treatment course. Outcomes were modified Rankin Scale score (mRS) at hospital discharge and most recent follow-up visit (minimum of 2 months post discharge), NICU and hospital length of stay, and long-term antiepileptic drug use.ResultsOf the 252 patients with refractory status epilepticus, 27/252 had NORSE and 26/27 of those had NOSRSE. Age was bimodally distributed with peaks at 27 and 63 years. The majority (96%) had an infectious or psychiatric prodrome. Etiology was cryptogenic in 73%, autoimmune in 19%, and infectious in 8%. Seven patients (27%) underwent brain biopsy, autopsy, or both; 3 (12%) were diagnostic (herpes simplex encephalitis, candida encephalitis, and acute demyelinating encephalomyelitis). On discharge, 6 patients (23%) had good or fair outcome (mRS 0–3). Of the patients with long-term follow-up data (median 9 months, interquartile range 2–22 months), 12 patients (71%) had mRS 0–3.ConclusionAmong our cohort, nearly all patients with NORSE had NOSRSE. The majority were cryptogenic with few antibody-positive cases identified. Neuropathology was diagnostic in 12% of cases. Although only 23% of patients had good or fair outcome on discharge, 71% met these criteria at follow-up.

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