scholarly journals Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist

2021 ◽  
Vol 10 (4) ◽  
pp. 881
Author(s):  
Jason B. Katz ◽  
Kent Owusu ◽  
Ilisa Nussbaum ◽  
Rachel Beekman ◽  
Nicholas A. DeFilippo ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Ketogenic Diet ◽  
Oral Care ◽  
Febrile Illness ◽  
Care Plan ◽  
Case Vignette ◽  
Successful Implementation ◽  
Bilateral Oophorectomy ◽  
Mortality And Morbidity ◽  
Diffusion Restriction

Background: Status epilepticus (SE) carries an exceedingly high mortality and morbidity, often warranting an aggressive therapeutic approach. Recently, the implementation of a ketogenic diet (KD) in adults with refractory and super-refractory SE has been shown to be feasible and effective. Methods: We describe our experience, including the challenges of achieving and maintaining ketosis, in an adult with new onset refractory status epilepticus (NORSE). Case Vignette: A previously healthy 29-year-old woman was admitted with cryptogenic NORSE following a febrile illness; course was complicated by prolonged super-refractory SE. A comprehensive work-up was notable only for mild cerebral spinal fluid (CSF) pleocytosis, elevated nonspecific serum inflammatory markers, and edematous hippocampi with associated diffusion restriction on magnetic resonance imaging (MRI). Repeat CSF testing was normal and serial MRIs demonstrated resolution of edema and diffusion restriction with progressive hippocampal and diffuse atrophy. She required prolonged therapeutic coma with high anesthetic infusion rates, 16 antiseizure drug (ASD) trials, empiric immunosuppression and partial bilateral oophorectomy. Enteral ketogenic formula was started on hospital day 28. However, sustained beta-hydroxybutyrate levels >2 mmol/L were only achieved 37 days later following a comprehensive adjustment of the care plan. KD was challenging to maintain in the intensive care unit (ICU) and was discontinued due to poor nutritional state and pressure ulcers. KD was restarted again in a non-ICU unit facilitating ASD tapering without re-emergence of SE. Discussion: There are inconspicuous carbohydrates in commonly administered medications for SE including antibiotics, electrolyte repletion formulations, different preparations of the same drug (i.e., parenteral, tablet, or suspension) and even solutions used for oral care―all challenging the use of KD in the hospitalized patient. Tailoring comprehensive care and awareness of possible complications of KD are important for the successful implementation and maintenance of ketosis.

scholarly journals How to Help Your Patients Enroll in the New-Onset Refractory Status Epilepticus (NORSE) and Febrile Infection-Related Epilepsy Syndrome (FIRES) Family Registry, and Other Rare Epilepsy Registries

2021 ◽  
pp. 153575972199832
Author(s):  
Karnig Kazazian ◽  
Marissa Kellogg ◽  
Nora Wong ◽  
Krista Eschbach ◽  
Raquel Farias Moeller ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Refractory Status Epilepticus ◽  
Epilepsy Syndrome ◽  
Neurologic Disorder ◽  
Mortality And Morbidity ◽  
Refractory Status ◽  
Rigorous Research ◽  
Active Epilepsy ◽  
New Onset

New-onset refractory status epilepticus (NORSE) is a rare clinical presentation of refractory status epilepticus (RSE) that occurs in people without active epilepsy or preexisting neurologic disorder. Febrile infection-related epilepsy syndrome (FIRES) is a subcategory of NORSE. New-onset refractory status epilepticus/FIRES are becoming increasingly recognized; however, information pertaining to disease course, clinical outcomes, and survivorship remains limited, and mortality and morbidity are variable, but often high. The objective of the NORSE/FIRES Family Registry is to (1) provide an easily accessible and internationally available multilingual registry into which survivors or NORSE/FIRES surrogates or family members of people affected by NORSE/FIRES or their physicians can enter data in a systematic and rigorous research study from anywhere in the world where internet is available; and (2) to examine past medical history, outcomes, and quality of life for people affected by NORSE/FIRES.

Norovirus Causes Pediatric Encephalopathy and Status Epilepticus: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Gabriela Tantillo ◽  
Navyamani Kagita ◽  
Maite LaVega-Talbott ◽  
Anuradha Singh ◽  
David Kaufman
Keyword(s):  
Magnetic Resonance Imaging ◽  
Case Report ◽  
Status Epilepticus ◽  
Magnetic Resonance ◽  
Review Of The Literature ◽  
Resonance Imaging ◽  
Common Cause ◽  
Diffusion Restriction ◽  
Neurologic Impairment ◽  
Norovirus Gastroenteritis

AbstractNorovirus is a common cause of acute gastroenteritis outbreaks worldwide. The disease can present with varying degrees of neurologic impairment from benign convulsions to rare cases of severe encephalopathy. We describe a case report of a North American infant who presented with norovirus gastroenteritis, status epilepticus, severe encephalopathy, and abnormal but reversible diffusion restriction changes on magnetic resonance imaging of brain.

scholarly journals Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran

2020 ◽  
Vol 14 (1) ◽  
pp. 95-102
Author(s):  
Mohammad Vafaee-Shahi ◽  
Elaheh Soltanieh ◽  
Hossein Saidi ◽  
Aina Riahi
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Brain Imaging ◽  
Morbidity And Mortality ◽  
Cross Sectional ◽  
Mortality And Morbidity ◽  
Imaging Results ◽  
History Of ◽  
Abnormal Brain ◽  
Febrile Status Epilepticus

Background: Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus. Methods: This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study. Results: The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36% versus 14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology. Conclusion: Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.

scholarly journals Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Simple F. Kothari ◽  
Gustavo G. Nascimento ◽  
Mille B. Jakobsen ◽  
Jørgen F. Nielsen ◽  
Mohit Kothari
Keyword(s):  
Brain Injury ◽  
Oral Health ◽  
Dental Plaque ◽  
Oral Care ◽  
Care Program ◽  
Care Plan ◽  
Multilevel Regression ◽  
Early Introduction ◽  
Brain Injured ◽  
Over Time

Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.Results: Dental plaque (P = 0.01) and total BOE score (P &lt; 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

2021 ◽  
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica Miller Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Implementation Strategies ◽  
Mobile App ◽  
Care Plan ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders&rsquo; inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

scholarly journals A Rare Case of Pansinusitis Fungal Mucormycosis with Orbital Involvement in Post COVID-19 Patient and Its Treatment

2021 ◽  
pp. 114-118
Author(s):  
Deepali Ghungrud ◽  
Ranjana Sharma ◽  
Seema Singh ◽  
Ruchira Ankar
Keyword(s):  
Fungal Infection ◽  
Eye Movement ◽  
White Blood Cells ◽  
Febrile Illness ◽  
Mortality And Morbidity ◽  
Team Members ◽  
Medical Practitioners ◽  
Loss Of Vision ◽  
History Of ◽  
Loss Of Appetite

Introduction: Covid-19 pandemic disease and its infections caused may be associated with bacterial and fungal co-infections. Case Presentation: A 61- year-old male patient, after Covid-19 disease admitted in hospital with the complaints of headache, right eye swelling, watering of right eyes, loss of vision since 2 days, also has history of loss of appetite, no history of febrile illness. Patient having history of diabetic mellitus but it was under control. As per physical examination left eye’s vision was reduced but eye movement was present. In right eye there was swelling of periorbital region, redness, watering of eyes was present and perception of light was negative due to damaged optic nerve. Loss of vision was found, eye movement was not present. Patient having mucormycosis fungal infection which was confirmed on culture test. All blood investigations were done. All reports were normal except white blood cells (WBC) were raised with 13400cu.mm. Random blood sugar (RBS) 250 mg%. Without delay medical treatment was started and patient was kept under strict observation.Spo2 were 97%, pulse rate 78 beats/ min. Conclusion: Here we would like to bring into notice that, Medical team members should know about the danger of secondary invasive fungal infection in a patient after Covid 19 disease. This type of cases can be prevented by using hygienic technique while handling of patient and proper standard treatment. It is necessary to prevent the spread of infection and its mortality and morbidity. Hence, medical practitioners should be aware of early clinical manifestation of the disease.

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

Status Epilepticus

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 939-940
Author(s):  
JEAN AICARDI ◽  
JEAN-JACQUES CHEVRIE
Keyword(s):  
Status Epilepticus ◽  
Brain Damage ◽  
Mortality And Morbidity ◽  
Considerable Evidence ◽  
Convulsive Seizures

Concerning the article by Maytal and colleagues and the accompanying editorial by Freeman, we have also found that the mortality and morbidity of cryptogenic status epilepticus has decreased considerably since our 1970 paper. Likewise, the incidence of acquired hemiplegia in France has become low during the same period. Contrary to Maytal et al, however, we believe that better and earlier control of convulsive status has played a role in this decrease. There is considerable evidence that convulsive seizures can produce brain damage, irrespective of the cause of attacks.

Medical emergencies

2019 ◽  
pp. 629-650
Author(s):  
Pete Murphy ◽  
Sarah Stibbards
Keyword(s):  
Risk Factors ◽  
Status Epilepticus ◽  
Diabetic Ketoacidosis ◽  
Medical Management ◽  
Convulsive Status Epilepticus ◽  
Early Extubation ◽  
Common Cause ◽  
Mortality And Morbidity ◽  
Medical Emergencies ◽  
Ventilation Strategies

This chapter is meant as a brief guide to the immediate management of medical emergencies that an anaesthetist may be called to assist with. It is not intended as an in-depth text on the conditions covered. The severity and immediate management of acute asthma are detailed, including tips on induction and ventilation strategies. An overview of bronchiolitis includes presentation, risk factors, medical management, and tips on intubation and ventilation. Convulsive status epilepticus is a common referral, and its causes, treatment and indications for intubation and early extubation are discussed. Diabetic ketoacidosis management is described, specifically including the treatment of cerebral oedema. A common cause of mortality and morbidity in children is sepsis, and in this final section of the chapter the ‘Sepsis 6’ approach is taken.

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