Efficacy of Intravenous Hydrocortisone Treatment in Refractory Neonatal Seizures: A Report on Three Cases

Neonatal seizures are the most common neurological emergency, and neonatal status epilepticus (NSE) remains a controversial entity, with no general consensus about its definition and treatment. Here, we report on three newborns with NSE refractory to first- and second-line antiepileptic drugs successfully treated with intravenous (IV) hydrocortisone. The patients had previously failed therapy with levetiracetam, phenobarbital and midazolam, showing persistent clinical and electrical seizures. Modulation of brain inflammation triggered during prolonged epileptic activity has been thought to potentially explain the beneficial effects of anti-inflammatory treatment.

Download Full-text

Comparative Efficacy and Safety of Antiepileptic Drugs for the Treatment of Status Epilepticus

Journal of Pharmacy Practice ◽

10.1177/0897190007305134 ◽

2007 ◽

Vol 20 (2) ◽

pp. 137-146 ◽

Cited By ~ 2

Author(s):

Steve S. Chung ◽

Norman C. Wang ◽

David M. Treiman

Keyword(s):

Status Epilepticus ◽

Antiepileptic Drugs ◽

Neuronal Damage ◽

Medical Emergency ◽

Second Line ◽

First Line Therapy ◽

Line Therapy ◽

Third Line Therapy ◽

Third Line ◽

Antiepileptic Medications

Status epilepticus (SE) is a medical emergency with high mortality rate. Common causes of SE include noncompliance with antiepileptic medications, drug- and alcohol-related etiologies, and central nervous system (CNS) infections. Because prolonged seizures can cause neuronal damage, treatment should be initiated promptly to avoid potential complications. Previous studies support intravenous (IV) lorazepam as first-line therapy and IV phenytoin or fosphenytoin as a second-line medication. If first-and second-line medications fail to control SE, further treatment with propofol, pentobarbital, midazolam, or other medications should be considered. Many of the drugs currently used to control SE are associated with sedation, respiratory suppression, hypotension, cardiac dysrhythmia, and anaphylactic reactions. Therefore, IV valproate or other newer antiepileptic drugs may be considered as an alternative third-line therapy for those who cannot tolerate the hypotensive effects of other anticonvulsants. This paper reviews comparative effectiveness and safety concerns among frequently used medications for SE.

Download Full-text

A rat model of organophosphate-induced status epilepticus and the beneficial effects of EP2 receptor inhibition

Neurobiology of Disease ◽

10.1016/j.nbd.2019.02.010 ◽

2020 ◽

Vol 133 ◽

pp. 104399 ◽

Cited By ~ 12

Author(s):

Asheebo Rojas ◽

Thota Ganesh ◽

Wenyi Wang ◽

Jennifer Wang ◽

Raymond Dingledine

Keyword(s):

Status Epilepticus ◽

Rat Model ◽

Beneficial Effects ◽

Receptor Inhibition ◽

Ep2 Receptor

Download Full-text

Levetiracetam versus fosphenytoin as a second-line treatment after diazepam for status epilepticus: study protocol for a multicenter non-inferiority designed randomized control trial

Trials ◽

10.1186/s13063-021-05269-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Kensuke Nakamura ◽

◽

Aiki Marushima ◽

Yuji Takahashi ◽

Akio Kimura ◽

...

Keyword(s):

Status Epilepticus ◽

Adverse Events ◽

Controlled Trial ◽

Insurance Coverage ◽

Line Treatment ◽

Second Line ◽

Open Label ◽

Consciousness Disturbance ◽

Multicenter Randomized Controlled Trial ◽

Severe Adverse Events

Abstract Background Status epilepticus (SE) is an emergency condition for which rapid and secured cessation is important. Phenytoin and fosphenytoin, the prodrug of phenytoin with less severe adverse effects, have been recommended as second-line treatments. However, fosphenytoin causes severe adverse events, such as hypotension and arrhythmia. Levetiracetam reportedly has similar efficacy and higher safety for SE; however, evidence to support its use for adult SE is lacking. In the present study, a non-inferiority designed multicenter randomized controlled trial (RCT) is being conducted to compare levetiracetam with fosphenytoin after diazepam as a second-line treatment for SE. Methods This multicenter, prospective, and open-label RCT is conducted in emergency departments. Between December 23, 2019, and March 31, 2023, 176 patients with convulsive SE transported to an emergency room will be randomized into a fosphenytoin group and levetiracetam group at a ratio of 1:1. The definition of SE is “continuous seizures longer than 5 min or discrete seizures longer than 2 min with intervening consciousness disturbance.” In both groups, diazepam is initially administered at 1–20 mg, followed by intravenous fosphenytoin at 22.5 mg/kg or intravenous levetiracetam at 1000–3000 mg. The primary outcome is the seizure cessation rate within 30 min. Seizure recurrence within 24 h, severe adverse events, and intubation rate within 24 h are secondary outcomes. Discussion The present study was approved and conducted as an initiative study of the Japanese Association for Acute Medicine. If non-inferiority is identified, the society will pursue an application for the national health insurance coverage of levetiracetam for SE via a public knowledge-based application. Trial registration Japan Registry of Clinical Trials jRCTs031190160. Registered on December 13, 2019

Download Full-text

Convulsive Disorders in Children, with Reference to Treatment with Ketogenic Diet

PEDIATRICS ◽

10.1542/peds.34.4.589b ◽

1964 ◽

Vol 34 (4) ◽

pp. 589-590

Author(s):

CESARE T. LAMBROSO

Keyword(s):

Antiepileptic Drugs ◽

Historical Review ◽

Pediatric Age ◽

Neonatal Seizures ◽

General Outline ◽

Ketogenic Diets ◽

Wide Range ◽

Convulsive Disorders ◽

Page Book ◽

Insight Into

This 300-page book covers a wide range of so-called convulsive disorders in the pediatric age, such as neonatal seizures, febrile fits, breathholding spells, and "hypsarhythmia," as well as a review of antiepileptic drugs and a series of do and don't questions most often asked by anxious parents, supplied with well-thought-out answers. Some 80 pages are devoted to a historical review, a description of the principles and the actual practice of ketogenic diets, including necessary but often neglected tables. This section, although clearly out of proportion to the general outline of the book, is possibly its greatest contribution, for it not only offers practical aid in a most difficult therapeutic enterprise, but also affords the reader some insight into the author's own experience.

Download Full-text

Midazolam for treatment of refractory neonatal seizures: a case report

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x1994000200019 ◽

1994 ◽

Vol 52 (2) ◽

pp. 260-262 ◽

Cited By ~ 7

Author(s):

José Luiz Dias Gherpelli ◽

Francisco José C. Luccas ◽

Israel Roitman ◽

Eduardo Juan Troster

Keyword(s):

Case Report ◽

Status Epilepticus ◽

Continuous Infusion ◽

Seizure Control ◽

Neonatal Period ◽

Hyaline Membrane Disease ◽

Water Soluble ◽

Neonatal Seizures ◽

Hyaline Membrane ◽

Ischemic Encephalopathy

Midazolam is a short-acting water soluble benzodiazepine that has been used with an increasing frequency in the last years. Although there are reports on its use in status epilepticus, there is none in the neonatal period. A pre-term (35 w) AGA newborn infant with a severe hypoxic-ischemic encephalopathy secondary to grade ED hyaline membrane disease developed status epilepticus in the first 6 hours of life and was successfully treated with midazolam after phenobarbital and phenytoin failed to achieve seizure control. Dosage schedule was 0.2 mg/kg IV, followed by continuous infusion of 0.025 mg/kg/h. Midazolam is an effective drug for neonatal status epilepticus and more experience should accumulate before it can be routinely employed in the neonatal period. This case shows that it is a possible option before using more dangerous drugs, such as thionembutal.

Download Full-text