Status Epilepticus as a Life-Threatening Manifestation of Myxedema Crisis

Abstract Background Status epilepticus (SE) is a life-threatening neurological disorder. The hippocampus, as an important area of the brain that regulates cognitive function, is usually damaged after SE, and cognitive deficits often result from hippocampal neurons lost after SE. Fyn, a non-receptor Src family of tyrosine kinases, is potentially associated with the onset of seizure. Saracatinib, a Fyn inhibitor, suppresses epileptogenesis and reduces epileptiform spikes. However, whether saracatinib inhibits cognitive deficits after SE is still unknown. Methods In the present study, a pilocarpine-induced SE mouse model was used to answer this question by using the Morris water maze and normal object recognition behavioral tests. Results We found that saracatinib inhibited the loss in cognitive function following SE. Furthermore, we found that the number of hippocampal neurons in the saracatinib treatment group was increased, when compared to the SE group. Conclusions These results showed that saracatinib can improve cognitive functions by reducing the loss of hippocampal neurons after SE, suggesting that Fyn dysfunction is involved in cognitive deficits after SE, and that the inhibition of Fyn is a possible treatment to improve cognitive function in SE patients.

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

Life and Science ◽

10.37185/lns.1.1.122 ◽

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.

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

Journal of Pharmacy Practice ◽

10.1177/0897190018756237 ◽

2018 ◽

Vol 32 (2) ◽

pp. 228-230 ◽

Cited By ~ 3

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.

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

International Journal of Epilepsy ◽

10.1016/j.ijep.2017.01.002 ◽

2017 ◽

Vol 04 (01) ◽

pp. 098-103 ◽

Cited By ~ 1

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.

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Status Epilepticus—Work-Up and Management in Children

Seminars in Neurology ◽

10.1055/s-0040-1719076 ◽

2020 ◽

Vol 40 (06) ◽

pp. 661-674

Author(s):

Cristina Barcia Aguilar ◽

Iván Sánchez Fernández ◽

Tobias Loddenkemper

Keyword(s):

Status Epilepticus ◽

Medical Emergency ◽

First Line ◽

Timely Manner ◽

Treatment Protocols ◽

Efficacious Treatment ◽

Life Threatening ◽

Diagnostic Work ◽

Work Up ◽

Medication Choice

AbstractStatus epilepticus (SE) is one of the most common neurological emergencies in children and has a mortality of 2 to 4%. Admissions for SE are very resource-consuming, especially in refractory and super-refractory SE. An increasing understanding of the pathophysiology of SE leaves room for improving SE treatment protocols, including medication choice and timing. Selecting the most efficacious medications and giving them in a timely manner may improve outcomes. Benzodiazepines are commonly used as first line and they can be used in the prehospital setting, where most SE episodes begin. The diagnostic work-up should start simultaneously to initial treatment, or as soon as possible, to detect potentially treatable causes of SE. Although most etiologies are recognized after the first evaluation, the detection of more unusual causes may become challenging in selected cases. SE is a life-threatening medical emergency in which prompt and efficacious treatment may improve outcomes. We provide a summary of existing evidence to guide clinical decisions regarding the work-up and treatment of SE in pediatric patients.

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Management of Status Epilepticus

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0039-1700446 ◽

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.

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LIFE-THREATENING DIPHENHYDRAMINE TOXICITY PRESENTING WITH STATUS EPILEPTICUS AND WIDE COMPLEX TACHYCARDIA: A CASE REPORT

CHEST Journal ◽

10.1016/j.chest.2019.08.2098 ◽

2019 ◽

Vol 156 (4) ◽

pp. A2159-A2160 ◽

Cited By ~ 1

Author(s):

Haneen Mallah ◽

John Makram ◽

Wasawat Vutthikraivit ◽

Saif El Naser El Nawaa ◽

Swagat Parajulee ◽

...

Keyword(s):

Case Report ◽

Status Epilepticus ◽

Wide Complex Tachycardia ◽

Life Threatening

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Vulnerable Sibling: Hyponatremia From Caries Prevention

PEDIATRICS ◽

10.1542/peds.79.4.637 ◽

1987 ◽

Vol 79 (4) ◽

pp. 637-639

Author(s):

DEBORAH L. CALLANAN ◽

LINDA B. HINER

Keyword(s):

Status Epilepticus ◽

Caries Prevention ◽

Professional Advice ◽

Vulnerable Child ◽

Child Syndrome ◽

Life Threatening ◽

Health And Development ◽

Life Threatening Event ◽

Older Sibling

Parental actions and beliefs shape every aspect of a child's health and development. Green and Solnit described a vulnerable child syndrome in which the child's development was impaired when the parents treated him or her in an inappropriate fashion because they had an unreasonable expectation that he or she would die. We recently cared for a child who suffered a life-threatening event (status epilepticus due to hyponatremia) because the parents were trying to avoid reproducing a serious, but not life-threatening, problem (nursing bottle caries) that had occurred in the older sibling. This distortion of professional advice created vulnerability to significant neurologic problems.

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A Comparison of Four Treatments for Generalized Convulsive Status Epilepticus

50 Studies Every Intensivist Should Know ◽

10.1093/med/9780190467654.003.0004 ◽

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.

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Autoimmune Encephalitis

Mayo Clinic Critical and Neurocritical Care Board Review ◽

10.1093/med/9780190862923.003.0104 ◽

2019 ◽

pp. 726-733

Author(s):

Eslam Shosha ◽

Sean J. Pittock

Keyword(s):

Intensive Care Unit ◽

Nervous System ◽

Intensive Care ◽

Status Epilepticus ◽

Autoimmune Encephalitis ◽

Behavioral Changes ◽

Diagnostic Challenge ◽

Clinical Presentations ◽

Autonomic Instability ◽

Life Threatening

Autoimmune encephalitis is an increasingly recognized, life-threatening disorder that, because of its variable clinical presentations, poses a diagnostic challenge in the intensive care setting. Patients with autoimmune encephalitis often need to be in an intensive care unit for management of life-threatening complications commonly related to multifocal nervous system involvement that includes status epilepticus, cognitive decline and behavioral changes, psychosis, and autonomic instability.

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