Status Epilepticus in Adults: A Review of Diagnosis and Treatment

2016 ◽  
Vol 36 (2) ◽  
pp. 62-73 ◽  
Author(s):  
Thomas Lawson ◽  
Susan Yeager
Keyword(s):  
Status Epilepticus ◽  
Antiepileptic Drugs ◽  
Systematic Approach ◽  
Neuronal Damage ◽  
Rapid Diagnosis ◽  
Frequent Occurrence ◽  
Nonconvulsive Status Epilepticus ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Medical Emergency

Status epilepticus is a medical emergency that requires rapid diagnosis and treatment. Nonconvulsive status epilepticus is frequently underdiagnosed and therefore undertreated, which can lead to permanent neuronal damage resulting in disability or death. Despite the frequent occurrence and morbidity associated with status epilepticus, this topic has received little attention within the literature. A systematic approach to treatment should start with management of airway, breathing, and circulation, followed by administration of benzodiazepines and intravenous antiepileptic drugs, and rapid escalation of therapy to prevent morbidity and mortality. Armed with the information in this article, nurses will have a higher-level understanding of what to do when encountering a patient in status epilepticus.

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

2007 ◽  
Vol 20 (2) ◽  
pp. 137-146 ◽  
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.

scholarly journals Examination of Demographic Characteristics of Drug and Corrosive Poisonings, Morbidity and Mortality in Children in terms of Emergency Department and Pediatric Surgery

2020 ◽  
Author(s):  
Cengiz Güney ◽  
Abuzer Coskun
Keyword(s):  
Emergency Department ◽  
Rapid Diagnosis ◽  
Morbidity And Mortality ◽  
Diagnosis And Treatment ◽  
Accidental Poisoning ◽  
Pharmacological Agents ◽  
Under Five ◽  
Common Causes ◽  
The Mean ◽  
Grade 3

Background: Poisoning constitutes an important part of morbidity and mortality among environmental emergencies that can be prevented, frequent in childhood, requiring rapid diagnosis and treatment. This study aimed was to examine the epidemiological, clinical and therapeutic characteristics of drug and corrosive poisonings in terms of children. Materials and Methods: Between January 2010 and December 2018, 1678 patients between the ages of 1-16 who applied to the emergency department with drug and corrosive poisoning were included in the study. The patients were divided into three groups as 1-5, 6-11 and over 12 years of age, and the substances with known pharmacological agents were divided into 10 groups. The Zargar Classification (7) was used to determine the degree of damage caused by corrosive substances in the esophagus. Results: The mean age of the patients was 8.32 ± 3.23 years (1-15 years). The girl/boy ratio of the cases was 1.18 / 1 and 54.3% were girls. 18.9% of the cases were under five years of age, 61% were between 6-11 years and 20% were older than 12 years. 94.6% of the patients were poisoned by drugs and 5.4% of them were poisoned due to non-drug reasons. Accidental poisoning was most commonly seen in children aged 6-11 and suicides were seen in children older than 12 years. It was found that 62.2% of the poisonings were accidental and 37.8% were suicidal. The most common causes of poisoning were analgesics and paracetamol exposure as a pharmacological agent. Mortality was found to be most common in 1-5 years age group and accidental poisonings. Accidental poisoning was common in girls and suicidal poisoning was common in boys. Grade 3 damage was found endoscopically in all of the mortalities due to corrosive substances. Conclusion: It was found that accidental poisoning was observed in children under five years of age, suicides were observed in children older than 12 years and the most important cause of mortality was due to corrosive substances. Cause-specific rapid diagnosis and treatment will contribute to the reduction of morbidity and mortality.

scholarly journals Refractory nonconvulsive status epilepticus in coma: analysis of the evolution of ictal patterns

2012 ◽  
Vol 70 (7) ◽  
pp. 501-505 ◽  
Author(s):  
Paulo Breno Noronha Liberalesso ◽  
Eliana Garzon ◽  
Elza Marcia T. Yacubian ◽  
Américo C. Sakamoto
Keyword(s):  
Status Epilepticus ◽  
Natural History ◽  
Nonconvulsive Status Epilepticus ◽  
Morbidity And Mortality ◽  
Loss Of Consciousness ◽  
Epileptiform Discharges ◽  
Neurological Morbidity ◽  
History Of ◽  
The Relationship

OBJECTIVE: Nonconvulsive status epilepticus (NCSE) is currently considered as one of the most frequent types of status epilepticus (SE). The objective of the present study was to identify the natural history of the electrographical evolution of refractory NCSE and to establish the relationship between ictal patterns and prognosis. METHODS: We analyzed, retrospectively, 14 patients with loss of consciousness and NCSE. The ictal patterns were classified as discrete seizures (DS), merging seizures (MS), continuous ictal discharges (CID), continuous ictal discharges with flat periods (CID-F), and periodic lateralized epileptiform discharges (PLEDs). RESULTS: The ictal patterns were DS (n=7; 50.0%), PLEDs (n=3; 1.4%), CID (n=2; 14.3%), MS (n=1; 7.1%), and CID-F (n=1; 7.1%). CONCLUSIONS: NCSE electrographic findings are heterogeneous and do not follow a stereotyped sequence. PLEDs were related to a higher probability of neurological morbidity and mortality.

scholarly journals Convulsive status epilepticus in children

2010 ◽  
Vol 63 (11-12) ◽  
pp. 801-804 ◽  
Author(s):  
Marija Knezevic-Pogancev ◽  
Ksenija Bozic ◽  
Tatjana Redzek-Mudrinic ◽  
Ksenija Gebauer-Bukurov
Keyword(s):  
Status Epilepticus ◽  
Neuronal Damage ◽  
Medical Emergency ◽  
Convulsive Status Epilepticus ◽  
Negative Effects ◽  
Rolandic Epilepsy ◽  
Febrile Convulsions ◽  
Early Management ◽  
Neurological Morbidity ◽  
Life Threatening

Introduction. Convulsive status epilepticus is the most urgent neurological medical emergency in children. Generalized convulsive status epilepticus is the most common and life-threatening type of status epilepticus. It is not a syndrome in the same sense as febrile convulsions, benign rolandic epilepsy, and infantile polymorphic epilepsy. These latter disorders have a tight age frame, seizure semiology, and a reasonably predictable outcome. Episodes of convulsive status epilepticus can occur in each: occasionally in symptomatic and febrile convulsions, and Lennox Gastaut syndrome, rarely in benign rolandic epilepsy, and West syndrome. Etiology of convulsive status epilepticus. Status epilepticus has many causes, which vary depending on the age and patient population. Convulsive status epileptucus continues to be associated with significant neurological morbidity and mortality, with different hazards and outcome. Although the outcome is dependent on etiology, it is known that appropriate early management may reduce mortality and some of the morbidity associated with convulsive status epilepticus. Discussion. Status epilepticus is a disorder in which the mechanisms attempting at terminating the seizure fail. Continued convulsive activity in convulsive status epilepticus results in decompensation of all organs and systems, thus being life threatening. Seizure activity in convulsive status epilepticus is associated with neuronal damage. The aim should be to halt this activity urgently, using, ideally, a 100% effective drug, administered quickly, without compromising the consciousness level or producing other negative effects on cardiovascular, respiratory function or other unexpected effects.

Seizures and Status Epilepticus

2018 ◽  
pp. 68-82
Author(s):  
Michael E. Reznik ◽  
Jan Claassen
Keyword(s):  
Status Epilepticus ◽  
Brain Injury ◽  
Neuronal Damage ◽  
Early Recognition ◽  
Acquired Brain Injury ◽  
Initial Therapy ◽  
Medical Emergency ◽  
Eeg Monitoring ◽  
Anesthetic Agents ◽  
Low Threshold

Seizures are common in the intensive care unit, both in patients with brain injury and those with other forms of critical illness. Many of these are nonconvulsive and have been increasingly recognized with the advent of continuous electroencephalography (EEG) monitoring. When seizures are prolonged or recur without a return to baseline, this is termed status epilepticus (SE)—a true medical emergency. Progression to refractory SE may occur quickly after onset, with a high potential for subsequent permanent neuronal damage. Successful management of SE therefore rests with early recognition and treatment, with a low threshold to begin anesthetic agents if seizures remain refractory to initial therapy. Meanwhile, a concurrent focus should be placed on airway, breathing, and circulation, as well as identifying the etiology of the seizures. Etiology is likely the best determinant of outcomes after SE (with outcomes worst for anoxic brain injury, followed by other newly acquired brain injury), while prolonged and refractory SE also portend a poorer prognosis.

THE CRITICALLY ILL CHILD: MANAGEMENT OF STATUS EPILEPTICUS

PEDIATRICS ◽  
1969 ◽  
Vol 44 (5) ◽  
pp. 732-733
Author(s):  
Sidney Carter ◽  
Arnold P. Gold
Keyword(s):  
Status Epilepticus ◽  
Neuronal Damage ◽  
Sudden Change ◽  
Medical Emergency ◽  
Medical Attention ◽  
Seizure Type ◽  
Epilepsia Partialis Continua ◽  
Reported Study ◽  
Symptomatic Epilepsy ◽  
Definition Of

Status epilepticus is the clinical definition of a state in which the patient has a series of recurrent convulsions without recovering consciousness between episodes. It can occur with any seizure type, but a true medical emergency usually exists only with the generalized or focal motor varieties of status. This definition of status epilepticus clearly excludes epilepsia partialis continua, in which there is no alteration of the state of consciousness, and serial epilepsy, where consciousness is regained between attacks. Status epilepticus occurs in 5 to 10% of children with epilepsy and requires immediate and continued medical attention, for, if uncontrolled, death or permanent neuronal damage could result. Death occurs in approximately 15% of patients with status and may either be related directly to status epilepticus or, as emphasized by Lombroso, may result from the untoward effect of intravenous sedatives or hypnotic compounds on the already depressed medullary centers. The immature nervous system is particularly vulnerable to status epilepticus; and, in one recently reported study, 50% of the children were 2 years of age or less. Prompt management is mandatory, as both the neurologic residua from irreversible cerebral damage and mortality are higher in this young age group. The true pathophysiology of status epilepticus is poorly understood. However, the condition is more common in children with symptomatic epilepsy of infectious, metabolic, vascular, or structural etiology. Rapid or sudden withdrawal of anticonvulsants and intercurrent infections are the common triggering mechanisms. Injudicious withdrawal of drugs either prior to an electroencephalogram or after a seizure-free state of relatively short duration, and a sudden change in the anti-convulsant regimen, are frequent precipitating factors.

Sign in / Sign up

Export Citation Format

Share Document