TY - JOUR. T1 - Status epilepticus in a population-based cohort with childhood-onset epilepsy in Finland. AU - Sillanpää, Matti. AU - Shinnar, Shlomo. PY - 2002/9/1. Y1 - 2002/9/1. N2 - Little is known about the time course over which status epilepticus occurs in childhood-onset epilepsy and its impact on long-term prognosis. A population-based cohort of 150 children younger than age 16 years with new onset epilepsy between 1961 and 1964 residing in the catchment area of Turku University Hospital was observed prospectively until 1997. The occurrence of status epilepticus and recurrent status epilepticus, risk factors for status epilepticus, and the impact of status epilepticus on prognosis were examined. Of the 150 cases, 41 patients (27%) experienced an episode of status epilepticus of whom 22 patients (56%) had two or more episodes. The risk of status epilepticus was highest at the onset of the disorder with 30 (73%) cases occurring before (n = 12) or at (n = 18) onset and 37 (90%) cases ...
Repetitive or prolonged seizures (status epilepticus) can damage neurons within the hippocampus, trigger gliosis, and generate an enduring state of hyperexcitability. Recent studies have suggested that microvesicles including exosomes are released from brain cells following stimulation and tissue injury, conveying contents between cells including microRNAs (miRNAs). Here, we characterized the effects of experimental status epilepticus on the expression of exosome biosynthesis components and analyzed miRNA content in exosome-enriched fractions. Status epilepticus induced by unilateral intra-amygdala kainic acid in mice resulted in acute subfield-specific, bi-directional changes in hippocampal transcripts associated with exosome biosynthesis including up-regulation of endosomal sorting complexes required for transport (ESCRT)-dependent and -independent pathways. Increased expression of exosome components including Alix were detectable in samples obtained 2 weeks after status epilepticus and changes
We retrospectively analysed the clinical characteristics, electroencephalogram (EEG) records, brain magnetic resonance imaging (MRI) scans, antiepileptic therapy and prognosis of a case series with ambulatory non-convulsive status epilepticus (NCSE) which evolved into a malignant form (mNCSE). mNCSE was defined as NCSE that continues or recurs five days or more after the onset of general anaesthesia, including those cases where NCSE recurs upon reduction or withdrawal of anaesthetic therapy. Four women and two men were studied. The mean age was 42.8 years (range: 19-63 years). Two of six patients had a previous diagnosis of epilepsy. Four patients died. Two patients had a good outcome with return to consciousness and activities of daily life, and one of these subjects developed temporal lobe epilepsy. In four patients, the cause of mNCSE was encephalitis. Clinical presentation was complex partial status epilepticus (CPSE) in three patients and generalised NCSE (GNCSE) in the other three. Two of ...
OBJECTIVES: Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome.. DESIGN: Retrospective assessment of a prospectively collected cohort.. SETTING: Academic hospital.. PATIENTS: Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013.. MEASUREMENTS AND MAIN RESULTS: We recorded prospectively demographics, clinical status epilepticus features, treatment, and outcome at discharge and retrospectively medical comorbidities, hospital stay, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with ...
As is the case with other non-convulsive status epilepticus forms, CPSE is dangerously underdiagnosed.[3] This is due to the potentially fatal yet veiled nature of the symptoms. Usually, an electroencephalogram, or EEG, is needed to confirm a neurologists suspicions. The EEG is also needed to differentiate between absence status epilepticus (which affects the entire brain), and CPSE, which only affects one region.[4] ...
In der Folge eines Status epilepticus entwickelt sich häufig eine chronische Epilepsie. In der vorliegenden Dissertation wurde die Fragestellung bearbeitet, ob ein Inhibitionsverlust im Gyrus dentatus Grundlage der Epileptogenese nach Status epilepticus ist. Ein selbst-erhaltender Status epilepticus (SSSE) wurde an erwachsenen Ratten durch elektrische Stimulation ausgelöst. Das Auftreten spontaner epileptischer Anfälle wurde im Verlauf von acht Wochen nach Status epilepticus zu drei Zeitpunkten (1, 4 und 8 Wochen) mittels Videoüberwachung erfasst. Zu denselben Zeitpunkten und vor Status epilepticus wurden elektrophysiologische Messungen im Gyrus dentatus durchgeführt. Die Aktivität der Prinzipalzellen des Gyrus dentatus unterliegt unter physiologischen Bedingungen einer ausgeprägten inhibitorischen Kontrolle. Durch Analyse von Doppelreizantworten wurden Veränderungen der Inhibition in dieser für die Epileptogenese relevanten Hirnstruktur beurteilt. Im Verlauf von acht Wochen nach SSSE ...
In der Folge eines Status epilepticus entwickelt sich häufig eine chronische Epilepsie. In der vorliegenden Dissertation wurde die Fragestellung bearbeitet, ob ein Inhibitionsverlust im Gyrus dentatus Grundlage der Epileptogenese nach Status epilepticus ist. Ein selbst-erhaltender Status epilepticus (SSSE) wurde an erwachsenen Ratten durch elektrische Stimulation ausgelöst. Das Auftreten spontaner epileptischer Anfälle wurde im Verlauf von acht Wochen nach Status epilepticus zu drei Zeitpunkten (1, 4 und 8 Wochen) mittels Videoüberwachung erfasst. Zu denselben Zeitpunkten und vor Status epilepticus wurden elektrophysiologische Messungen im Gyrus dentatus durchgeführt. Die Aktivität der Prinzipalzellen des Gyrus dentatus unterliegt unter physiologischen Bedingungen einer ausgeprägten inhibitorischen Kontrolle. Durch Analyse von Doppelreizantworten wurden Veränderungen der Inhibition in dieser für die Epileptogenese relevanten Hirnstruktur beurteilt. Im Verlauf von acht Wochen nach SSSE ...
Synonyms for status epilepticus in Free Thesaurus. Antonyms for status epilepticus. 1 word related to status epilepticus: epilepsy. What are synonyms for status epilepticus?
Delayed first-line benzodiazepine treatment is independently associated with major adverse outcomes in children with status epilepticus (SE), according to a JAMA Neurology study. The results raise the question as to whether poor outcomes could, in part, be prevented by earlier administration of treatment.. Patients in the status epilepticus study were admitted with refractory convulsive SE to 11 pediatric tertiary hospitals in the United States and stratified into two groups - those who received timely first-line benzodiazepine (i.e., given within less than 10 minutes of seizure onset); and those who received treatment within 10 or more minutes.. The status epilepticus study associated an untimely treatment with a higher frequency of death, use of continuous infusions, longer convulsion duration, and more frequent hypotension. These findings may change the perception of acute seizure and status epilepticus treatment, tentatively converting it into an extremely time-sensitive emergency that is ...
Status epilepticus refractory to first-line and second-line antiepileptic treatments challenges neurologists and intensivists as mortality increases with treatment refractoriness and seizure duration. International guidelines advocate anesthetic drugs, such as continuously administered high-dose midazolam, propofol, and barbiturates, for the induction of therapeutic coma in patients with treatment-refractory status epilepticus. The seizure-suppressing effect of anesthetic drugs is believed to be so strong that some experts recommend using them after benzodiazepines have failed. Although the rationale for the use of anesthetic drugs in patients with treatment-refractory status epilepticus seems clear, the recommendation of their use in treating status epilepticus is based on expert opinions rather than on strong evidence. Randomized trials in this context are lacking, and recent studies provide disturbing results, as the administration of anesthetics was associated with poor outcome independent ...
We studied the efficacy and safety of midazolam given as a continuous infusion in the treatment of refractory generalized convulsive status epilepticus (RGCSE). We carried out a prospective, open study, in 19 patients (11 men) with RGCSE in the intensive care unit at Firat Medical Center in Elazig. When intravenous administration of 0.3 mg/kg diazepam (three times at 5-min intervals), 20 mg/kg phenytoin, and 20 mg/kg phenobarbital failed to bring the episode under control, patients were administered an intravenous bolus of midazolam (200 μg/kg) followed by a continuous infusion at 1 μg/kg min. The dose was increased by 1 μg/kg min every 15 min until the episode of seizure was brought under control. The time from beginning of treatment to control of seizures, infusion rate, and side-effects were monitored. The mean age of the patients was 40.4 years (range 16-87 years). The clinical etiology of RGCSE was idiopathic epilepsy (6 cases), anoxicischemic cerebral insult due to cardiac arrest (3), viral
A Taskforce for the Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) has proposed a new definition of status epilepticus: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1). It is a condition, which can have long-term consequences (after time point t2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. The Taskforce also proposed a new diagnostic classification system for status epilepticus that consists of 4 axes: Semiology, Etiology, Electroencephalography (EEG) correlates; and Age. Each axis is further divided into subcategories, providing a framework for clinical diagnosis, investigation, and therapeutic approaches for patients. Trinka E, Cock H, Hesdorffer D, ...
Objectives: To investigate the localization and progressive changes of cyclic-AMP dependent protein kinase (cPKA) in the mouse hippocampus at acute stages during and after pilocarpine induced status epilepticus. Methods: Pilocarpine induced status epilepticus mice were sacrificed 30 min, 2 h or 1 day after the start of a ∼7 h lasting status as assessed by video-electroencephalography. Brains were processed for quantitative immunohistochemistry of hippocampal cPKAβ and cPKAγ, and immunohistochemical co-localization of cPKAβ and cPKAγ with calbindin (CB), calretinin (CR), and parvalbumin (PV). Results: Based on anatomical and morphological assessment, cPKAβ was primarily expressed by principal cells and cPKAγ by interneurons. In CA1, cPKAβ co-localized with 76% of CB, 41% of CR, and 95% of PV-immunopositive cells, while cPKAγ co-localized with 50% of CB, 29% of CR, and 80% of PV-immunopositive cells. Upon induction of status epilepticus, cPKAβ expression was transiently reduced in CA1, ...
TY - JOUR. T1 - Baseline and outcome assessment in pediatric status epilepticus. AU - Jafarpour, Saba. AU - Stredny, Coral M.. AU - Piantino, Juan. AU - Chapman, Kevin E.. PY - 2018/1/1. Y1 - 2018/1/1. N2 - Purpose: To summarize different aspects of short and long-term outcomes associated with SE, including mortality, recurrence, subsequent epilepsy, neurocognitive dysfunction, imaging abnormalities, and health-related quality of life. Methods: We searched MEDLINE for studies that assessed the short-term and long-term outcome of status epilepticus in pediatric population, including mortality, recurrence of seizure and status epilepticus, neurological, cognitive, or behavioral impairment, and health-related quality of life. We excluded studies that exclusively assessed the adult population. Results: Mortality in pediatric SE is relatively low, while morbidity poses more challenges. The underlying cause of SE has been shown to be a major determinant in the outcome after SE. However, it is ...
We identified 395 patients with ICU-treated RSE, corresponding to an annual incidence of 3.4/100,000 (95% confidence interval (CI) 3.04-3.71). Hospital mortality was 7.4% (95% CI 0-16.9%), and 1-year mortality was 25.4% (95% CI 21.2-29.8%). Mortality at hospital discharge was associated with severity of organ dysfunction. Mortality at 1 year was associated with older age (adjusted odds ratio (aOR) 1.033, 95% CI 1.104-1.051, p = 0.001), sequential organ failure assessment (SOFA) score (aOR 1.156, CI 1.051-1.271, p = 0.003), super-refractory status epilepticus (SRSE) (aOR 2.215, 95% CI 1.20-3.84, p = 0.010) and dependence in activities of daily living (ADL) (aOR 2.553, 95% CI 1.537-4.243, p , 0.0001). Conclusions ...
Excessive recurrent seizures have been shown to produce epileptic brain damage (EBD), which has been demonstrated by many cases of intractable human epilepsy and the studies of various experimental animal models. Hippocampal sclerosis (HS) or mesial temporal sclerosis (MTS) are typical EBDs and are seen in kainic acid (KA) induced models1-5 and in intractable human temporal lobe epilepsy.6,7 On the other hand, the occurrence of EBD in the dog has been controversial because different reports suggest either no specific pathological findings in several cases of idiopathic epilepsy8-11 or similar findings as HS/MST12-15.. Previously, we studied the canine model of KA-induced complex partial status epilepticus4,5. In those studies, although KA was injected into the unilateral amygdala and the partial seizures of early stage started at the injected amygdala, secondary generalized seizures and contralateral partial seizures with secondary generalized seizures were observed frequently during SE. ...
Most increases resolved inside 10 to fifteen minutes, however in some cases, will increase were observed at 45 minutes following administration ,see,Clinical Pharmacology (12. Indirect estimates for the incidence of non-convulsive standing epilepticus have been as high as 14-24 per 100,000 inhabitants per year (the vast majority of these are non-convulsive status epilepticus within the setting of learning difficulties). With cardiac radionuclide gated wall motion studies (a number of-gated acquisition scans) or echocardiograms measuring ejection fraction ,a href=http://garyjdean.com/programs/agenda209/,buy rel="nofollow" eskalith 300mg fast delivery,/a,. Many drugs platelet function successfully might no longer be able to produce work together with the platelet membrane and trigger a clinically sigthat impact. Though multi-stage interventions that include environmental and coverage adjustments are anticipated to provide broad and lengthy-lasting impacts, much less rigorous research designs must ...
A seizure that lasts at least 30 minutes is called status epilepticus, or a prolonged seizure. This is a medical emergency that may lead to permanent brain damage or death. Many medical experts become concerned that a seizure is status epilepticus after it lasts 5 to 10 minutes.
A seizure that lasts at least 30 minutes is called status epilepticus, or a prolonged seizure. This is a medical emergency that may lead to permanent brain damage or death. Many medical experts become concerned that a seizure is status epilepticus after it lasts 5 to 10 minutes.
A seizure that lasts at least 30 minutes is called status epilepticus, or a prolonged seizure. This is a medical emergency that may lead to permanent brain damage or death. Many medical experts become concerned that a seizure is status epilepticus after it lasts 5 to 10 minutes.
A seizure that lasts at least 30 minutes is called status epilepticus, or a prolonged seizure. This is a medical emergency that may lead to permanent brain damage or death. Many medical experts become concerned that a seizure is status epilepticus after it lasts 5 to 10 minutes.
Electrical status epilepticus during slow-wave sleep (ESESS) which is also known as continuous spike-wave of slow sleep (CSWSS) is type of electroencephalographic (EEG) pattern which is seen in ESESS/CSWSS/epilepsy aphasia spectrum. This EEG pattern can occur alone or with other syndromes. Its etiology is not clear, however, brain malformations, immune disorders, and genetic etiologies are suspected to contribute. We aimed to perform a systematic review of all genetic etiologies which have been reported to associate with ESESS/CSWSS/epilepsy-aphasia spectrum. We further aimed to identify the common underlying pathway which can explain it. To our knowledge, there is no available systematic review of genetic etiologies of ESESS/CSWSS/epilepsy-aphasia spectrum. MEDLINE, EMBASE, PubMed and Cochrane review database were searched, using terms specific to electrical status epilepticus during sleep or continuous spike-wave discharges during slow sleep or epilepsy-aphasia spectrum and of studies of genetic
The most common medical neurologic emergency in childhood, status epilepticus (SE) is a serious and often life-threatening medical emergency.The definition, pathophysiology, classification, risk factors, and outcome of status epilepticus in children
Various etiological factors such as head injury, chemical intoxication, tumors, and gene mutation can induce epileptogenesis. In animal models, status epilepticus (SE) triggers epileptogenesis. In humans, convulsive SE for |30 minutes can be a life threatening medical emergency. The duration and severity of convulsive SE are highly variable in chemoconvulsant animal models. A continuous video-EEG recording, and/or diligent direct observation, facilitates quantification of exact duration of different stages of convulsive seizures (Racine stages 3-5) to determine the severity of SE. A continuous convulsive SE for |30 minutes usually causes high mortality in some rodents and results in widespread brain damage in the surviving animals, in spite of treating with antiepileptic drugs (AEDs). AEDs control behavioral seizures, but not EEG seizures. The severity of initial SE impacts epileptogenesis and cognitive function, therefore, quantitative assessment of behavioral SE and EEG in animal models is useful to
This book is designed to meet the need for a practically oriented textbook on the rapidly growing field of continuous EEG (cEEG) monitoring. A wide range of key clinical aspects are addressed, with explanation of status epilepticus classification, criteria for institution of monitoring, seizure patterns and their recognition, quantitative EEG analysis, and neuroimaging in patients undergoing cEEG monitoring. The value of cEEG and the nature of cEEG findings in various special situations are then reviewed, covering particular pathologies, critical care considerations, and prognostication. Treatments of nonconvulsive status epilepticus (NCSE) and nonconvulsive seizures (NCS) are discussed. The concluding section is devoted to important administrative issues including billing, staffing issues, comparison of EEG machines, and information technology (IT) issues ...
Non-convulsive status epilepticus (NCSE) is present in 10-30% of ICU patients with altered mental status (AMS) and is associated to poor outcomes. To our knowledge, there is no data describing the prevalence and outcomes of critically ill cancer patients with AMS associated to non-convulsive seizures (NCS) or NCSE. We aim to describe the outcomes and risk factors of critically ill cancer patients with encephalopathy associated with non-convulsive seizures (NCS). This is a 3-year prospective observational study in a mixed oncological ICU at MD Anderson Cancer Center. Data of ICU patients with moderate to severe encephalopathy (Glasgow Coma Score | 13) that underwent EEG monitoring to rule out NCS were collected. Multivariate logistic regression was performed to identify risk factors and outcomes. Of the 317 patients with encephalopathy who underwent EEG monitoring, 14.5% had NCS. Known risk factors such as sepsis, CNS infection, antibiotics, and cardiac arrest were not associated with increased risk of
In our study patients were considered to have RSE if children were still having active convulsions despite receiving injection lorazepam intravenously at a dose of 0.1 mg/kg (max 4 mg) at a rate maximum upto 2 mg/min or intravenous diazepam at a dose of 0.2 - 0.3 mg/Kg (maximum 10 mg) slowly or intravenous midazolam at a dose of 0.15 - 0.2 mg/kg(max 5 mg). In case of children with difficult intravenous access buccal/nasal midazolam 0.2 - 0.3 mg/kg (maximum 5 mg) per rectal diazepam 0.5 mg/kg (maximum 10 mg) or intramuscular midazolam 0.2 mg/kg (maximum 5 mg). If seizure continued at 5 minutes, a repeat dose of benzodiazepine was given with same dose. At 10 minutes, if the seizure activity still remains intravenous phenytoin was given at a dose of 20mg/kg(maximum- 1000mg) at a rate of 1mg/kg/minute or intravenous fosphenytoin at 20mg PE/kg (if available) at a rate of 3mg PE/kg/minute.. Patients having seizure activity despite administration of above medications were considered to have RSE. Out of ...
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Activated microglia, astrogliosis, expression of pro-inflammatory cytokines, blood brain barrier (BBB) leakage and peripheral immune cell infiltration are features of mesial temporal lobe epilepsy. Numerous studies correlated the expression of pro-inflammatory cytokines with the activated morphology of microglia, attributing them a pro-epileptogenic role. However, microglia and myeloid cells such as macrophages have always been difficult to distinguish due to an overlap in expressed cell surface molecules. Thus, the detrimental role in epilepsy that is attributed to microglia might be shared with myeloid infiltrates. Here, we used a FACS-based approach to discriminate between microglia and myeloid infiltrates isolated from the hippocampus 24 h and 96 h after status epilepticus (SE) in pilocarpine-treated CD1 mice. We observed that microglia do not express MHCII whereas myeloid infiltrates express high levels of MHCII and CD40 96 h after SE. This antigen-presenting cell phenotype correlated with ...
Seizures and status epilepticus (SE) occur more commonly in oncologic patients than the general population. Similarly, seizures are more common in critically ill patients, and thus critically ill...
A succession of seizures without regaining consciousness between attacks or one prolonged convulsion lasting 30 minutes or more.. Status epilepticus can occur with partial, complex partial, absence, tonic-clonic, or clonic seizures and may result in respiratory embarrassment with cyanosis and hypoglycaemia.. ...
The aim of the proposed research is to compare the diagnostic accuracy of a portable wireless electroencephalography (EEG) device (Biosignal Micro-EEG) to standard EEG in identifying abnormal EEG patterns (mainly non-convulsive seizure and non-convulsive status epilepticus) in emergency department (ED) patients with altered mental status. Comparing the the accuracy of EEG recordings and interpretations of Micro-EEG to those of standard EEG will allow the investigators to assess the utility of this novel device in the ED patients with altered mental status. The unique qualities of Micro-EEG device could potentially facilitate easier access to EEG test in all ED patients.. This study will also provide valid information regarding the prevalence of non-convulsive seizure in ED patients with altered mental status.The gold standard for diagnosing non-convulsive seizure would be standard EEG.. All study participants will undergo electroencephalography using the two devices (standard EEG and micro-EEG) ...
Clinical trial for nervous system disorder , Study of Midazolam Hydrochloride Oromucosal Solution (MHOS/SHP615) in Pediatric Patients With Status Epilepticus (Convulsive) in the Community Setting
Status Epilepticus. In: Hay, Jr WW, Levin MJ, Deterding RR, Abzug MJ. Hay, Jr W.W., Levin M.J., Deterding R.R., Abzug M.J. Eds. William W. Hay, Jr, et al.eds. Quick Medical Diagnosis & Treatment Pediatrics New York, NY: McGraw-Hill; . http://accesspediatrics.mhmedical.com/content.aspx?bookid=2196§ionid=167755738. Accessed December 12, 2017 ...
TY - CHAP. T1 - Status epilepticus. AU - Wray, Carter. AU - Knupp, Kelly. PY - 2011/12/1. Y1 - 2011/12/1. UR - http://www.scopus.com/inward/record.url?scp=84882481237&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=84882481237&partnerID=8YFLogxK. U2 - 10.1016/B978-0-323-05405-8.00090-5. DO - 10.1016/B978-0-323-05405-8.00090-5. M3 - Chapter. AN - SCOPUS:84882481237. SN - 9780323054058. SP - 370. EP - 373. BT - Bermans Pediatric Decision Making. PB - Elsevier Inc.. ER - ...
RATIONALE: Refractory status epilepticus (RSE) is the persistence of status epilepticus despite second-line treatment. Super-refractory SE (SRSE) is characterized by ongoing status despite 48â ¯h of anaesthetic treatment. Due to the high case fatality in RSE of 16-39%, off label treatments without strong evidence of efficacy in RSE are often administered. In single case-reports and small case series totalling 28 patients, acute implantation of VNS in RSE was associated with 76% and 26% success rate in generalized and focal RSE respectively. We performed an updated systematic review of the literature on efficacy of VNS in RSE/SRSE by including all reported patients. METHODS: We systematically searched EMBASE, CENTRAL, Opengre.eu, and ClinicalTrials.gov, and PubMed databases to identify studies reporting the use of VNS for RSE and/or SRSE. We also searched conference abstracts from AES and ILAE meetings. RESULTS: 45 patients were identified in total of which 38 were acute implantations of VNS in ...
Pilocarpine-induced status epilepticus. The pilocarpine-induced model of chronic epilepsy in rats (Turski et al., 1983, 1989; Cavalheiro et al., 1991; Mello et al., 1993) was chosen because it replicates several features of human temporal lobe epilepsy. Male Sprague Dawley rats (36-60 d old; 102-210 gm) were injected with methylscopolamine and terbutaline (2 mg/kg, i.p.). Thirty minutes later, experimental rats received a single injection of pilocarpine HCl, whereas sham-treated rats received saline injections. Although a range of pilocarpine doses (315-350 mg/kg, i.p.) was tested with the aim to produce the highest proportion of rats experiencing status epilepticus with the lowest mortality rate, a concentration of 335 mg/kg was used for ,90% of the experiments. Seizure duration and frequency progressively increased until a state of SE characterized by rearing and falling was achieved. SE was allowed to proceed for 75-90 min and then was terminated with sodium pentobarbital (25-50 mg/kg, i.p.). ...
Ceftriaxone is widely used in patients for the treatment of serious gram-negative infections. Ceftriaxone can induce some potential side effects, including neurotoxicity, however, nonconvulsive status epilepticus has rarely been reported. We report a
In 2015, the International League Against Epilepsy (ILAE) proposed a conceptual definition that applies to all types of SE: (1) SE starts as a condition resulting from failure of seizure-termination mechanisms or the initiation of pathological mechanisms that likely lead to continuous seizure activity, and (2) SE creates long-term consequences that begin to occur after the onset of SE, including neuronal death, neuronal injury, and alteration of neuronal networks. This definition hinges on the identification of the semiology of SE: the clinical manifestations of seizure activity (Table 16-1). Specifically for generalized CSE, criterion 1 is defined when seizures last longer than 5 minutes and criterion 2 occurs at the point that long-term consequences begin to appear, around 30 minutes.1 Convulsive SE is also defined as recurrent seizures between which there is incomplete recovery of consciousness.4 ...
Drexel University College of Medicine researchers are conducting an emergency medicine study to find out the most effective drug for treating established status epilepticus - a life-threatening condition in which the brain is in a state of persistent seizure.. Patients with established status epilepticus (ESE) have one or repeated seizures lasting longer than five minutes and do not respond to a full dose of typical medication, like valium. There are an estimated 120,000 to 180,000 episodes of SE in the United States each year. Emergency room doctors across the country use a variety of drugs to treat the condition, however, the most effective treatment is not yet known.. The Established Status Epilepticus Treatment Trial (ESETT) is a randomized, four-year, multi-center study to learn which treatment is most effective at stopping a seizure quickly.. Hahnemann University Hospital - the College of Medicines primary teaching affiliate - is one of more than 40 sites participating in the trial. Each ...
The age-related functional changes underlying epileptogenesis remain to be clarified. in the present study, we explored the correlation between metabolic changes, neuronal damage and epileptogenesis during the acute, silent and chronic phases following status epilepticus (SE) induced by lithium-pilocarpine (Li-Pilo) in 10- (P10), 21-day-old (P21) and adult rats. Local cerebral metabolic rates for glucose (LCMRglcs) were measured by the [C-14]2-deoxyglucose method during SE, the silent period and the interictal phase of the chronic period. Neurodegeneration was assessed by cresyl violet staining. During SE, LCMRglcs dramatically increased at all ages mainly in forebrain vulnerable regions. During the silent phase, in P21 and adult rats, metabolic decreases were recorded in damaged forebrain regions involved in the genesis and propagation of seizures 14 days after SE. At the end of the silent phase, P21 and adult rats exhibited metabolic increases in intact brainstem areas involved in the remote ...
Electroencephalogram (EEG) is essential when monitoring the effects of anaesthetics in the treatment of RSE. Although the primary goal of treatment is seizure control, the optimal extent of EEG suppression remains controversial: seizure suppression, burst suppression, or flat recording. There is no evidence from either prospective or retrospective studies to suggest an adequate effect.35 Critical care continuous EEG monitoring is recommended to monitor the efficacy of continuous infusions of midazolam, propofol, or thiopentone. It can confirm seizure cessation and absence of seizure recurrence. Concurrent video recording is also strongly recommended as a supplement to clinical examination. If available, the EEG recording should be initiated as soon as possible after treatment of RSE, be continued until seizures are controlled for at least 24 hours, and preferably be continued for another 24 hours after the agent is withdrawn. Non-convulsive seizures are common after treatment of convulsive ...
A writing subcommittee reviewed the literature to derive evidence-based recommendations to help clinicians answer the following critical questions: (1) In patients with a first generalized convulsive seizure who have returned to their baseline clinical status, should antiepileptic therapy be initiated in the emergency department to prevent additional seizures? (2) In patients with a first unprovoked seizure who have returned to their baseline clinical status in the emergency department, should the patient be admitted to the hospital to prevent adverse events? (3) In patients with a known seizure disorder in which resuming their antiepileptic medication in the emergency department is deemed appropriate, does the route of administration impact recurrence of seizures? (4) In emergency department patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of a benzodiazepine, which agent or agents should be administered next to terminate ...
Emergency Neurological Life Support (ENLS) is a series of protocols suggesting important steps to take in the first hour of a neurological emergency. ENLS is designed to help healthcare professionals improve patient care and outcomes during the most crucial time - the critical first hours of the patients neurological emergency. ENLS demonstrates a collaborative, multi-disciplinary approach and provides a consistent set of protocols, practical checklists, decision points, and suggested communication to use during patient management. These emergencies include Ischemic Stroke, Intracerebral Hemorrhage, Status Epilepticus, Subarachnoid Hemorrhage, Meningitis and Encephalitis, Airway Management including intubating a patient with high intracranial pressure, Traumatic Brain Injury, Traumatic Spine injury and Spinal Cord Compression.. ...
Airway opening manoeuvres with high flow oxygen (10-15 litre/minute via face-mask with reservoir bag) and suction secretions as needed.. Consider nasopharyngeal airway if difficultly maintaining airway (insertion of oropharyngeal airway normally not possible due to clenched teeth).. Indications for intubation include inability to maintain/protect airway, apnoea or if seizure doesnt terminate following phenytoin/phenobarbitone loading dose. Intubation may be considered, even if the seizure has terminated, to allow CO2 control in suspected raised intracranial pressure or to facilitate safe transfer for neuroimaging.. Call Anaesthetist/Intensivist when starting phenytoin/phenobarbitone or if airway concerns at any stage.. If intubation is required a rapid sequence induction should be performed using thiopentone 4mg/kg (2 mg/kg in neonates). All induction agents must be used with caution and the dose stated should be adjusted according to response and the patients haemodynamic status i.e. ...
Dr. Yi-Chen Lai is a board-certified pediatric intensive care physician with a long-standing interest in neuroscience. He completed two years of research traini...
Free, official coding info for 2018 ICD-10-CM G40.909 - includes detailed rules, notes, synonyms, ICD-9-CM conversion, index and annotation crosswalks, DRG grouping and more.
Introduction Limited data describe the frequency timing or indications for endotracheal intubation (ETI) in patients with status epilepticus. Department (ED) or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years < 0.001) and men underwent ETI more Pravadoline (WIN 48098) than women (26 vs 21 % = 0.047). Patients with ongoing seizures on ED introduction had a higher rate of ETI (32 vs 16 % < 0.001) as did those who received rescue anti-seizure medication (29 vs 20 % = 0.004). Mortality was higher for intubated patients (7 vs 0.4 % < 0.001). Most ETI (= 133 Pravadoline (WIN 48098) 62 %) occurred early (prior to or within 30 min after ED introduction) and late ETI was associated with higher mortality (14 vs 3 % = 0.002) than early ETI. Conclusions ETI is usually common in patients with status epilepticus ...
Prolonged seizures can cause neurological damage; about 1 in 5 cases is fatal. How is this condition identified and treated, and what new treatment options are