scholarly journals Refractory and Super-Refractory Status Epilepticus in Nerve Agent-Poisoned Rats Following Application of Standard Clinical Treatment Guidelines

2021 ◽  
Vol 15 ◽  
Author(s):  
Julia E. Morgan ◽  
Sara C. Wilson ◽  
Benjamin J. Travis ◽  
Kathryn H. Bagri ◽  
Kathleen T. Pagarigan ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Treatment Guidelines ◽  
Refractory Status Epilepticus ◽  
Male Rats ◽  
Small Subset ◽  
Breakthrough Seizure ◽  
Threatening Condition ◽  
Life Threatening ◽  
Third Line ◽  
Current Guidelines

Nerve agents (NAs) induce a severe cholinergic crisis that can lead to status epilepticus (SE). Current guidelines for treatment of NA-induced SE only include prehospital benzodiazepines, which may not fully resolve this life-threatening condition. This study examined the efficacy of general clinical protocols for treatment of SE in the specific context of NA poisoning in adult male rats. Treatment with both intramuscular and intravenous benzodiazepines was entirely insufficient to control SE. Second line intervention with valproate (VPA) initially terminated SE in 35% of rats, but seizures always returned. Phenobarbital (PHB) was more effective, with SE terminating in 56% of rats and 19% of rats remaining seizure-free for at least 24 h. The majority of rats demonstrated refractory SE (RSE) and required treatment with a continuous third-line anesthetic. Both ketamine (KET) and propofol (PRO) led to high levels of mortality, and nearly all rats on these therapies had breakthrough seizure activity, demonstrating super-refractory SE (SRSE). For the small subset of rats in which SE was fully resolved, significant improvements over controls were observed in recovery metrics, behavioral assays, and brain pathology. Together these data suggest that NA-induced SE is particularly severe, but aggressive treatment in the intensive care setting can lead to positive functional outcomes for casualties.

scholarly journals Intensive Care Management of Multiorgan Dysfunction and Hypoxic Brain Injury Secondary to Refractory Status Epilepticus

2021 ◽  
Vol 2 (4) ◽  
pp. 3
Author(s):  
Sanum Kashif
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
High Grade Fever ◽  
Refractory Status ◽  
Hypoxic Brain Injury ◽  
Hypoxic Brain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Permanent Brain Damage

Refractory Status Epilepticus (RSE) is a medical emergency that may lead to permanent brain damage or death.Mortality rate is 16-39%. It is the life threatening condition in which continuous fits occur, despite treatmentwith benzodiazepines and one antiepileptic drug.A 25-year-old female, brought in emergency department with high-grade fever and frequent fits. GlasgowComa Scale (GCS) was 3/15 with unstable hemodynamics. Resuscitation started immediately and managed asstatus epilepticus. Patient was in multi organ failure on arrival. On the basis of history and examination, hypoxicbrain injury was diagnosed initially. Later on, refractory status epilepticus (RSE) with multi organ dysfunctionsyndrome (MODS) was diagnosed, after necessary investigations and treatment. Patient was managed as ateam with multidisciplinary approach and after continuous effort of 2 weeks, patient was successfullydischarged to home.

scholarly journals Treatment of refractory status epilepticus with electroconvulsive therapy: Need for future clinical studies

2017 ◽  
Vol 04 (01) ◽  
pp. 098-103 ◽  
Author(s):  
Anindya Ray
Keyword(s):  
Status Epilepticus ◽  
Electroconvulsive Therapy ◽  
Low Cost ◽  
Refractory Status Epilepticus ◽  
Medical Emergency ◽  
Therapeutic Modality ◽  
Future Research ◽  
Systematic Research ◽  
Threatening Condition ◽  
Life Threatening

AbstractStatus epilepticus (SE) is a serious medical emergency. Refractory-SE non-responsive to anesthetic medication is a life threatening condition with very high mortality rate. Proper management of those cases is a big medical challenge. Over the last two decades there are anecdotal reports of successful management of such cases with electroconvulsive therapy (ECT) in 12 patients of different age group with variable pattern of seizures and different etiology. However, there is no systematic research about it. ECT is a well-known safe, easy- to-administer, low-cost therapeutic modality in the field of neuro-psychiatry. Thus its potential to treat refractory-SE which essentially lacks effective management should be evaluated in future research. The objectives of this article are to do a thorough literature review on use of ECT in refractory-SE; mechanism of action of ECT in refractory-SE; and finally formulate a working protocol for future study of using ECT in patients of refractory-SE.

scholarly journals Super-refractory status epilepticus and pharmacoresistant epilepsy in the infant with hemorrhagic shock and encephalopathy syndrome

2020 ◽  
pp. 117-117
Author(s):  
Ruzica Kravljanac ◽  
Marija Djakovic ◽  
Biljana Vucetic-Tadic ◽  
Djordje Kravljanac
Keyword(s):  
Status Epilepticus ◽  
Hemorrhagic Shock ◽  
De Novo ◽  
Epileptic Seizures ◽  
Refractory Status Epilepticus ◽  
Pharmacoresistant Epilepsy ◽  
Course Of Disease ◽  
Refractory Status ◽  
Threatening Condition ◽  
Life Threatening

Introduction. Hemorrhagic shock and encephalopathy syndrome (HSES) is a rare disorder with prevalence at the early age. The main features of HSES are: acute diarrhea, shock, disseminated intravascular coagulation, multisystem impairment, and encephalopathy. The prognosis is very poor, with high mortality, especially in the cases with status epilepticus. Case outline. The presented infant had typical features of HSES associated with superrefractory status epilepticus as de novo epileptic event, followed by parmacoresistant epilepsy. Clinical course of disease was very severe and required urgent circulatory and respiratory support, and at the same time, managing of super-refractory status epilepticus by continuous intravenous infusion of midazolam, barbiturate and levetiracetam. The outcome was very poor with serious neurological consequence and resistant epileptic seizures. Conclusion. The treatment of the presented patient with HSES was very challengeable due to life threatening condition associated with superrefractory status epilepticus, and further pharmacoresistant epilepsy. Additionally, the choice of antiepileptic drugs is limited due to multisystem impairment and adverse effects, which might worsen, anyhow, severe course of disease.

scholarly journals Anesthetic Use In Status Epilepticus: A Concise Review

2020 ◽  
pp. 20-36
Author(s):  
Furkan M. Yilmaz ◽  
Lauren A. Igneri ◽  
Yasir A. Yilmaz ◽  
Evren Burakgazi-Dalkilic
Keyword(s):  
Status Epilepticus ◽  
Recent Literature ◽  
Refractory Status Epilepticus ◽  
Clinical Use ◽  
Concise Review ◽  
Refractory Status ◽  
Line Therapy ◽  
Agent Selection ◽  
Third Line Therapy ◽  
Third Line

The purpose of this review is to summarize the recent literature focusing on intravenous (IV) administration of commonly used anesthetics, including midazolam, pentobarbital/ thiopental, propofol, and ketamine in the treatment of status epilepticus (SE). Anesthetics should be reserved as third-line therapy for the treatment of SE when benzodiazepines and other second-line agents fail to terminate the seizure. We have reviewed the literature related to the treatment of status epilepticus, refractory status epilepticus, super-refractory status epilepticus, anesthetics, midazolam, pentobarbital/thiopental, propofol, and ketamine. This paper focuses on the pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the treatment of SE with an emphasis on the developing literature supporting the use of ketamine for this indication. Based on the available literature, we propose recommendations for third-line agent selection in the management of SE.

Successful Phenobarbital Desensitization After DRESS Reaction in the Management of Refractory Status Epilepticus

2018 ◽  
Vol 32 (2) ◽  
pp. 228-230 ◽  
Author(s):  
Robert H. Witcher ◽  
Michelle M. Ramirez
Keyword(s):  
Drug Reaction ◽  
Status Epilepticus ◽  
Signs And Symptoms ◽  
Punch Biopsy ◽  
Refractory Status Epilepticus ◽  
Burst Suppression ◽  
Refractory Status ◽  
Life Threatening ◽  
Antiepileptic Medications ◽  
Systemic Symptoms

Purpose: Drug reaction with eosinophilia and systemic symptoms (DRESS) is associated with antiepileptic drug use and is a rare but life-threatening side effect. We present a case of phenobarbital-induced DRESS in a patient who subsequently required phenobarbital and was successfully desensitized. Summary: A 5-year-old male presented with medically refractory status epilepticus (SE). He had been trialed on several antiepileptic medications without achieving burst suppression. Burst suppression was achieved with a pentobarbital infusion, and thus, phenobarbital was initiated as the pentobarbital was weaned. After five days of phenobarbital, the patient developed signs and symptoms concerning for DRESS; a punch biopsy confirmed the drug reaction. Two months later, he again developed SE unresponsive to antiepileptic infusions. Burst suppression was achieved with pentobarbital, and it was decided to transition the patient to phenobarbital. Due to concerns of phenobarbital-induced DRESS, the patient underwent a phenobarbital desensitization consisting of 6 doses sequentially administered in 10-fold increasing concentrations before achieving therapeutic dosing. Three days later, the patient achieved therapeutic phenobarbital levels, was weaned off of pentobarbital, and remained seizure-free without recurrence of DRESS. Conclusions: Graded desensitization may be an option to minimize recurrence of DRESS in patients where avoidance of the offending agent is not possible.

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.

A Comparison of Four Treatments for Generalized Convulsive Status Epilepticus

2018 ◽  
pp. 21-26
Author(s):  
Jason L. Sanders ◽  
Jarone Lee
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Convulsive Status Epilepticus ◽  
Line Treatment ◽  
First Line ◽  
Cooperative Study Group ◽  
Intention To Treat ◽  
Intravenous Diazepam ◽  
Life Threatening ◽  
First Line Treatment

Generalized convulsive status epilepticus (GCSE) is a life-threatening emergency, and multiple agents have been advocated for the initial treatment. The VA Status Epilepticus Cooperative Study Group conducted a randomized, blinded trial comparing intravenous diazepam followed by phenytoin, lorazepam, phenobarbital, or phenytoin as first-line treatment for GCSE. In the intention-to-treat analysis, no significant difference in treatment was observed across all groups for patients with either overt GCSE or subtle GCSE. Among patients with verified-diagnosis overt GCSE, lorazepam was most successful at achieving cessation of seizures, though no difference was observed among patients with verified-diagnosis subtle GCSE. Results from this trial and two others establish benzodiazepines as the favored first line treatment of GCSE. Investigations are ongoing comparing benzodiazepines to newer antiepileptic drugs. The Established Status Epilepticus Trial will be the first randomized trial comparing fosphenytoin, levetiracetam, and valproic acid for benzodiazepine-refractory status epilepticus in children and adults.

Misery of insufficient treatment guidelines in post-traumatic epilepsy

2019 ◽  
Vol 7 (3) ◽  
pp. e000716
Author(s):  
Franziska Riese ◽  
Nina Meyerhoff ◽  
Jasmin Nessler ◽  
Andrea Tipold
Keyword(s):  
Traumatic Brain Injury ◽  
Status Epilepticus ◽  
Brain Injury ◽  
Adverse Events ◽  
Treatment Guidelines ◽  
Life Threatening ◽  
Post Traumatic ◽  
Cluster Seizures ◽  
Post Traumatic Epilepsy ◽  
Traumatic Epilepsy

Two dogs were presented after traumatic brain injury (TBI): a Jack Russell Terrier (JRT) kicked by a horse and a Magyar Vizsla (MV) hit by train. Both dogs developed seizures immediately after trauma and were treated successfully with antiepileptic drugs (AEDs) for 1 month (JRT) with imepitoin and for half a year (MV) with phenobarbital. After discontinuing the antiepileptic therapy, both dogs developed seizures again resulting in death of the JRT in status epilepticus. The MV was treated again with AEDs and continued to have cluster seizures every 2 weeks. In conclusion, it can be recommended to treat dogs with immediate seizures continuously after TBI with AEDs, if no life-threatening adverse events occur.

scholarly journals Refractory status epilepticus – a major problem for the practitioners

2021 ◽  
Vol 64 (2) ◽  
pp. 12-15
Author(s):  
Cornelia Calcii ◽  
◽  
Svetlana Hadjiu ◽  
Mariana Sprincean ◽  
Ludmila Feghiu ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Medical Intervention ◽  
Mortality And Morbidity ◽  
Cns Infections ◽  
Refractory Status ◽  
Risk Of Mortality ◽  
Antiepileptic Medication ◽  
Common Causes ◽  
Life Threatening

Introduction: Status epilepticus (SE) is a life-threatening neurological emergency requiring immediate medical intervention and is associated with high mortality and morbidity. The aim of this research was evaluation of clinical and etiological profile of refractory status epilepticus (RSE) among children aged between 1 month and 18 years. Material and methods: The study was done between January 1, 2017 and December 24, 2019. All children with the age limits mentioned above, who presented convulsive SE, subsequently with development in refractory status epileptic (RSE), were included in the study. Patients were investigated and evaluated according to a standard protocol. Subsequently, the characteristics of children with RSE and those without an evolution in RSE were compared. Results: 55 children, out of whom 32 boys with SE were enrolled in the study, of which 20 children (36%) developed RSE. Central nervous system (CNS) infections were the most common causes of SE and development of RSE (51% in SE and 53% in RSE, p > 0.05). Noncompliance of antiepileptic medication served as the second cause for evolution of RSE. The overall mortality rate was 10.9%, the chances of death in RSE (20%) being higher than in SE (5.7%). The unfavorable prognosis was seven times higher in children with RSE, compared to children who developed SE. Conclusions: In the management of CNS infections, pediatricians should be aware of the high risk of developing RSE. In addition, the possibility of developing RSE should be considered and promptly managed in an intensive care unit in order to reduce the risk of mortality and morbidity of this severe neurological condition

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