scholarly journals Status Epilepticus Management: A Short Review

2016 ◽  
Vol 8 (2) ◽  
Author(s):  
Martin Savard MD
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
Short Review ◽  
High Morbidity ◽  
First Line ◽  
Recurrent Seizure ◽  
Electrographic Seizure ◽  
History Of ◽  
Medical Teams ◽  
Based Medicine

Status epilepticus is a common neurological emergency, with high morbidity and mortality, now defined as 5 minutes or more of (1) continuous clinical and/or electrographic seizure activity or (2) recurrent seizure activity without recovery (returning to baseline) between seizures. In observational studies, many disparities exist in management among different medical teams. Here, the author reviews evidence-based medicine data on this management, with emphasis on the use of drugs and electroencephalography. Benzodiazepine (either IV lorazepam or IM midazolam) are the recognized first line of treatment. When a patient is still seizing thereafter, the second line is usually either IV phenytoin or IV valproate, where available. A persisting status epilepticus should then be considered as refractory and managed with anaesthetic drug, keeping in mind that the natural history of that state is to evolve to nonconvulsive status epilepticus, where an emergent EEG is the only way to diagnose that condition with certainty.

scholarly journals Sudden altered mental state in the elderly: nonconvulsive status epilepticus and the role of the Emergency Department

2011 ◽  
Vol 5 (1) ◽  
pp. 15-25
Author(s):  
Rocco Galimi
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
The Elderly ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Recurrent Seizure ◽  
Memory Problems ◽  
Altered Mental State ◽  
New Onset

In the elderly, new onset of epilepsy is often associated with vague complaints such as confusion, altered mental status, or memory problems. The absence of clinically apparent convulsions in association with an electroencephalogram showing continuous or recurrent seizure activity has been called nonconvulsive status epilepticus (NCSE). The purpose of this article is to describe the clinical and electroencephalographic features of NCSE in older adults. NCSE is an important, under-recognised and reversible cause of acute prolonged confusion. Although attempts have been made to define and classify this disorder, there is no universally accepted definition or classification yet that encompasses all subtypes or electroclinical scenarios. A urgent electroencephalogram is considered as the method of choice in the diagnostic evaluation of NCSE. Further researches are needed to better define NCSE.

Noncompliance Contributing to Apparent Drug Failure in Status Epilepticus

PEDIATRICS ◽  
1974 ◽  
Vol 53 (6) ◽  
pp. 938-940
Author(s):  
John T. Wilson
Keyword(s):  
Status Epilepticus ◽  
Plasma Levels ◽  
Seizure Activity ◽  
Drug Level ◽  
Continuous Control ◽  
Drug Plasma ◽  
Intravenous Diazepam ◽  
Grand Mal ◽  
History Of ◽  
Drug Plasma Levels

The case to be described illustrates apparent drug failure because of noncompliance in the drug delivery system, and the sequelae of this mishap. In connection with investigation of this case further occurrences of noncompliance were found. This incident also brings into focus the importance of plasma drug level determinations for effective application of therapy. CASE REPORT A 7-year-old, 26-kg, black girl was admitted with a 16-month history of nonprogressive neurologic disease accompanied by clinical and EEG evidence of petit mal and grand mal epilepsy which responded to diphenylhydantoin (DPH), phenobarbital or ethosuximide (Zarontin) treatment. Generalized convulsions had been infrequent for four months, but, before the present admission, a marked increase in grand mal seizures was noted. On the day of admission (day 1), recurrent generalized seizure activity progressed to status epilepticus within six hours. Intravenous diazepam (Valium [0.18/mg/kg]) controlled the seizures. Primidone (Mysoline), 250 mg tid, and ethosuximide, 500 mg tid were prescribed as maintenance anticonvulsants in an attempt to allay further progression to status epilepticus. For the next several days her seizures could be controlled only with paraldehyde (0.36 mg/kg intravenously), although administration of other drugs was continued. Assays of drug plasma levels did not become available until day 6. They disclosed that plasma levels of diazepam and demethyldiazepam were high (289 and 50 ng/ml, respectively) one hour after dosing with 0.18 mg/kg. This indicated that diazepam was not effective for continuous control of seizures, but this information was not acted upon immediately. The most striking finding was that primidone was not detected in plasma, although the prescibed dosage was 250 mg tid.

Diagnosis and Management of Status Epilepticus

2021 ◽  
Vol 41 (05) ◽  
pp. 483-492
Author(s):  
Abrar O. Al-Faraj ◽  
Myriam Abdennadher ◽  
Trudy D. Pang
Keyword(s):  
Status Epilepticus ◽  
Emergency Room ◽  
Seizure Activity ◽  
Diagnostic Evaluation ◽  
High Morbidity ◽  
Pharmacological Management ◽  
Systemic Complications ◽  
Diagnosis And Management ◽  
The Common ◽  
New Onset

AbstractSeizures are among the most common neurological presentations to the emergency room. They present on a spectrum of severity from isolated new-onset seizures to acute repetitive seizures and, in severe cases, status epilepticus. The latter is the most serious, as it is associated with high morbidity and mortality. Prompt recognition and treatment of both seizure activity and associated acute systemic complications are essential to improve the overall outcome of these patients. The purpose of this review is to provide the current viewpoint on the diagnostic evaluation and pharmacological management of patients presenting with status epilepticus, and the common associated systemic complications.

scholarly journals Pharmacotherapy of Rhino-Orbital- Cerebral Mucormycosis

2021 ◽  
Vol 70 (2) ◽  
Author(s):  
Manisha Bisht ◽  
Sampan Singh Bist
Keyword(s):  
Amphotericin B ◽  
Early Stage ◽  
Short Review ◽  
Medical Intervention ◽  
High Dose ◽  
High Morbidity ◽  
First Line ◽  
Basic Principles ◽  
Resource Limited ◽  
Amphotericin B Deoxycholate

The aim of this study is Recently there is an alarming increase in the incidence of mucormycosis in patients diagnosed with Covid -19. In this short review, we will discuss the basic principles of mucormycosis treatment, antifungal agents used along with update on pharmacotherapeutic guidelines recommended for management of mucormycosis. Searching the Pubmed with the key words “mucormycosis and covid 19 ”, “ Treatment of mucormycosis”, “ antifungal used in Mucormycosis revealed many articles, and the relevant articles were screened. Mucormycosis is an aggressive disease which is difficult to diagnose in early stage with high morbidity and mortality. Multimodal therapeutic approach consisting of early diagnosis, urgent surgical and medical intervention and elimination of predisposing factors is key to successful management of this condition. First-line antifungal agent is high-dose liposomal amphotericin B although amphotericin B deoxycholate may be the viable option in resource limited settings.

Generalized convulsive status epilepticus after retrograde type A aortic dissection surgery

Perfusion ◽  
2020 ◽  
pp. 026765912094315
Author(s):  
Yuan Li ◽  
Qingchen Wu ◽  
Haoming Shi ◽  
Dan Chen ◽  
Cheng Zhang
Keyword(s):  
Status Epilepticus ◽  
Aortic Dissection ◽  
Seizure Activity ◽  
Good Condition ◽  
Type A ◽  
Convulsive Status Epilepticus ◽  
Recurrent Seizure ◽  
Type A Aortic Dissection ◽  
Generalized Seizures ◽  
First Time

Introduction: Generalized convulsive status epilepticus is defined as a generalized and convulsive seizure with 5 minutes or more of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery between seizures. For the first time, we present a case with retrograde type A aortic dissection after endovascular repairment and received thoracotomy intensely. Case report: The patient experienced frequent generalized seizures in the immediate postoperative period, and status epilepticus was considered for his medical history, clinic symptoms and related examinations. Discussion and Conclusion: Generalized convulsive status epilepticus should be alert for avoiding delay in the rehabilitation particularly after aortic dissection surgery. Under the good condition of ventilation, combining morphine with midazolam or diazepam can more effectively relieve the symptoms.

scholarly journals CLINICAL PROFILE AND OUTCOME OF CHILDREN ADMITTED WITH STATUS EPILEPTICS

2021 ◽  
Vol 5 (9) ◽  
Author(s):  
Sushil Kuamr Bakolia ◽  
Gajendra Kumar Verma ◽  
Dinesh Kumar Barolia
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
Cross Sectional Study ◽  
Clonic Seizure ◽  
Clinical Profile ◽  
Convulsive Status Epilepticus ◽  
Age Group ◽  
Cross Sectional ◽  
Recurrent Seizure ◽  
Appropriate Treatment

Background: Objective of this study was to study epidemiology and clinical profile of Status epilepticus Methods: Hospital based cross sectional study conducted on 50 children All children aged between 1 month to 12 years who at presentation or during the PICU stay had convulsive status epilepticus - defined as continuous seizure activity or recurrent seizure activity without regaining consciousness lasting for >5 min. Results: Among 50 children 56.00 % were in the age group were less than 5 years ,24 % were between 6-10 years ,20.00 % were above 10 yrs. The mean age group was 6.21±1.26 years. Incidence was higher in males (64%) when compared to females (36%). Generalized tonic clonic seizure were observed in 46 (92.00%) and partial seizure was noted in 4 (8%) of the children. About 36 (72%) of the children developed SE for the first time. Conclusion: Status epilepticus is one of the common neurological emergency which requires admission to PICU. In our study epilepsy is one of the most common causes of status epilepticus. Early and appropriate treatment with anticonvulsants and use of mechanical ventilation may improve the outcome. Keywords: Status epilepticus, mortality, clinical profile

Status Epilepticus

2019 ◽  
pp. 687-692
Author(s):  
Christopher P. Robinson ◽  
Sara E. Hocker
Keyword(s):  
Status Epilepticus ◽  
Neurocritical Care ◽  
Seizure Activity ◽  
Nonconvulsive Status Epilepticus ◽  
Care Society ◽  
Recurrent Seizure ◽  
Neurologic Emergency

Status epilepticus (SE) is a medical and neurologic emergency defined as persistent seizure activity lasting longer than 5 minutes or recurrent seizure activity without return to baseline between events. Several classifications exist. The Neurocritical Care Society recommends a simplified classification in which SE is dichotomized as convulsive or nonconvulsive, with nonconvulsive status epilepticus further stratified as focal or generalized.

scholarly journals Effects of Three Anti-Seizure Drugs on Cholinergic and Metabolic Activity in Experimental Status Epilepticus

2019 ◽  
Vol 22 ◽  
pp. 340-351 ◽  
Author(s):  
Imran Imran ◽  
Konrad Koch ◽  
Henrik Schöfer ◽  
Helene Lau ◽  
Jochen Klein
Keyword(s):  
Oxidative Stress ◽  
Valproic Acid ◽  
Status Epilepticus ◽  
Metabolic Activity ◽  
Seizure Activity ◽  
In Vivo Microdialysis ◽  
Ach Release ◽  
Recurrent Seizure ◽  
Pilocarpine Model

Purpose. Status epilepticus (SE) is characterized by recurrent seizure activity and can be drug-resistant. Knowledge of neuronal and metabolic activity of the brain during SE may be helpful to improve medical care. We here report the effects of three anti-seizure drugs on changes of acetylcholine energy metabolites and oxidative stress during SE. Methods. We used the lithium-pilocarpine model in rats to induce SE and in vivo-microdialysis to monitor cholinergic and metabolic activity in the hippocampus. We measured extracellular concentrations of acetylcholine, glucose, lactate, pyruvate, glycerol and isoprostanes before and during SE, and after acute treatment with pregabalin, valproic acid, and levetiracteam. Results. Upon onset of  SE, acetylcholine (ACh) release increased six- to eightfold. Glucose was increased only transiently by 30% but lactate levels rose four-fold, and extracellular concentrations of glycerol ten-fold. Isoprostanes are markers of oxidative stress and increased more than 20-fold. Two hours after pilocarpine adminstration, rats were treated with pregabalin (100 mg/kg), levetiracetam (200 mg/kg) or valproic acid (400 mg/kg) by i.p. injection. All three drugs stopped seizure activity in a delayed fashion, but at the doses indicated, only animals that received levetiracetam reached consciousness. All drugs reduced ACh release within 60-120 minutes. Lactate/pyruvate ratios, glycerol and isoprostanne levels were also reduced significantly after drug administration. Conclusions. Hippocampal ACh release closely follows seizure activity in SE and is attenuated when SE subsides. Pregabalin, valproic acid and levetiracetam all terminate seizures in the rat SE model and attenuate cholinergic and metabolic changes within two hours.

Seizure

2018 ◽  
pp. 129-135
Author(s):  
Olga Kovalerchik
Keyword(s):  
Emergency Department ◽  
Status Epilepticus ◽  
Medical Therapy ◽  
Seizure Activity ◽  
Diagnostic Testing ◽  
Treatment Algorithm ◽  
First Line ◽  
Third Line ◽  
Rapid Treatment

Status epilepticus is defined as more than two seizures without recovery between the episodes or when seizure activity persists for 5 minutes or more. This chapter reviews management of a seizing patient in the emergency department, which begins with consideration of the airway, then breathing and circulation. The rapid treatment algorithm starts with benzodiazepines, the first-line medical therapy for seizure activity and status epilepticus, and may include second- and third-line agents. Diagnostic testing and the need for imaging will depend on details specific for the patient presenting with seizure-like activity. The chapter examines the topic based on the case of a patient brought to the emergency department having suffered a seizure.

Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

2007 ◽  
Vol 12 (2) ◽  
pp. 4-8
Author(s):  
Frederick Fung
Keyword(s):  
Concentration Level ◽  
Treatment Plan ◽  
Toxic Exposure ◽  
Dose Response Relationship ◽  
Specialty Board ◽  
History Of ◽  
Subjective Complaints ◽  
Based Medicine ◽  
Illness Causation ◽  
Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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