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Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings.

PURPOSE: We compared propofol with high-dose barbiturates in the treatment of refractory status epilepticus (RSE) and propose a protocol for the administration of propofol in RSE in adults, correlating propofol's effect with plasma levels. METHODS: Sixteen patients with RSE were included; 8 were treated primarily with high-dose barbiturates and 8 were treated primarily with propofol. RESULTS: Both groups of patients had multiple medical problems and a subsequent high mortality. A smaller but not statistically significant fraction of patients had their seizures controlled with propofol (63%) …

Взрослые и дети имеют статус координатора по вопросам эпилепсии и эпилепсии continua.

Эпилептический эпилептический и эпилепсиа particentis continua (FSE-EPC) наиболее часто встречается с хроническим хроническим прогрессивным энцефалитом Расмуссена и русским весенним энцефалитом. FSE-EPC, возможно, является характерной особенностью некетотического гипергликемического сахарного диабета, но чаще всего его называют поздним осложнением, особенно если имеет место сопутствующее церебральное повреждение, например церебральное инфаркт. FSE-EPC может быть связан с множественным склерозом, первичными или метастатическими опухолями мозга, синдромом МЕРРФ-МЕЛАС, доброкачественной эпилепсие

Совпадение в аннотации оригинала
Focal status epilepticus and epilepsia partialis continua (FSE-EPC) are most frequently seen with chronic focal progressive encephalitis of Rasmussen and Russian spring-summer encephalitis. FSE-EPC may be the presenting feature of nonketotic hyperglycemic diabetes mellitus but is more often noted as a late complication especially if there is a coexistent cer…

[Effects of thyrotropin-releasing hormone (TRH) on status epilepticus in rats].

Recent studies have demonstrated that intramuscular administration of thyrotropin-releasing hormone (TRH) or its analogue improves various clinical aspects of intractable epilepsy such as Lennox-Gastaut syndrome, West syndrome, and myoclonus epilepsy. Other clinical studies reported efficient property of intravenous TRH against status epilepticus. However, it is also true that intravenous TRH produces epileptic seizures in patients with epilepsy or organic brain damage. Thus, the utility of intravenous TRH for the treatment of status epilepticus seems to be equivocal. To further explore the pr…

Periodic febrile confusion as a presentation of complex partial status epilepticus.

A 75-year-old woman was evaluated for recurrent episodes of fever she experienced periodically every 4-5 weeks over the last 12 months, lasting 2-3 days each. The fever was associated with continuous complex partial seizures, paralleled the seizure activity and returned to normal after the seizures had ceased. The ictal EEG recordings showed rhythmic bitemporal 3-4 Hz activity; the interictal recordings showed a spike and wave discharge over the right fronto-temporal region. Carbamazepine effectively controlled both the seizures and the fever; the latter was presumed to be an inherent manifest

Predisposing Factors of Progression from Refractory Status Epilepticus to Super-Refractory Status Epilepticus in ICU-Admitted Patients: Multicenter Retrospective Cohort Study in a Resource-Limited Setting.

BACKGROUND: Super-refractory status epilepticus (SRSE) is an extremely serious neurological emergency. Risk factors and mechanisms involved in transition from refractory status epilepticus (RSE) to SRSE are insufficiently studied. METHODS: This was a multicenter retrospective cohort study of consecutive patients diagnosed and treated for RSE at two reference hospital over 5 years in Ecuador. A total of 140 patients were included. Potential demographic, clinical, and treatment variables that may predict progression from refractory to SRSE were analyzed. RESULTS: Super-refractory status epilep…

Reversible ipsilateral triple-region diffusion restriction after post-traumatic status epilepticus.

This is a Neuro-Images submission. Per the journal's Instructions for Authors, Neuro-Images articles do not require an abstract. A brief summary is provided below for indexing purposes: A 41-year-old man with post-traumatic epilepsy developed status epilepticus after self-discontinuing antiseizure medications for two months. Brain MRI demonstrated simultaneous diffusion restriction in the right frontal cortex, body of the corpus callosum, and right hippocampus, with concordant right-hemispheric EEG epileptiform activity. All imaging abnormalities resolved completely on day 11, and the patient …

Quality of life over time after new onset refractory status epilepticus.

OBJECTIVE: This study aims to better characterize the long-term neurological quality of life (QOL) outcomes (using the Neuro-QOL scale) in survivors of new onset refractory status epilepticus (NORSE), including its subtype febrile infection-related epilepsy syndrome (FIRES), and provide guidance for psychological and social support strategies. METHODS: Utilizing data from a multicenter prospective study of NORSE/FIRES led by Yale University, we enrolled patients who completed the validated, patient-reported Neuro-QOL scale at least once at 3-6 months (n = 37), 12 months (n = 29), 24 months (n…

Electrographic and Clinical Determinants of Good Outcome After Postanoxic Status Epilepticus.

BACKGROUND AND OBJECTIVES: Postanoxic electrographic status epilepticus (PSE) affects up to a third of all comatose patients after cardiac arrest (CA) and is associated with high mortality. Late PSE onset (>24 hours), from a restored continuous background pattern, and absence of established indicators of poor outcome at multimodal prognostication are described in survivors. We aimed to determine the increase in probability of good long-term outcome after PSE in patients presenting with this favorable PSE profile compared with all patients with PSE. METHODS: This is a prospective observational…

Microglial TREM2 promotes phagocytic clearance of damaged neurons after status epilepticus.

In the central nervous system, triggering receptor expressed on myeloid cells 2 (TREM2) is exclusively expressed by microglia and is critica … tly promoted seizure-induced pathology. We found that TREM2 KO increased both the severity of acute status epilepticus and the number of spontaneous recurrent seizures characteristic of chronic focal epilepsy. Phagocytic clearance of damaged neurons by microglia was also impaired by TREM2 KO and reduced phagocytic activity correlated with increased spontaneous seizu …

Prophylactic antiseizure medications for recurrent status epilepticus in nonsyndromic childhood epilepsy.

PURPOSE: The management of status epilepticus (SE) has mainly focused on the termination of ongoing SE episodes. However, long-term therapeutic strategies for the prevention of SE are lacking. This study aimed to investigate the effectiveness of prophylactic antiseizure medications (ASMs) for SEs in nonsyndromic childhood epilepsy. METHODS: This retrospective study was conducted at Jikei University Hospital. Patients <18 years of age, diagnosed with epilepsy, and experiencing three or more SE episodes within 1 year between April 1, 2017, and October 1, 2021, were included. ASMs introduced for…

Early vigabatrin to augment GABAergic pathways in post-anoxic status epilepticus.

The outcomes of patients who experience status epilepticus during the post-cardiac arrest period, or post-anoxic status epilepticus (PASE), remain dismal despite advances in resuscitation. The combination of therapeutic nihilism and the refractoriness of seizures in a setting where pessimistic prognostic impressions prevail is likely the main driver of such poor outcomes. The resulting pervasive vicious cycle perpetuates this knowledge gap, whereby hypoxic-ischemic insults as the etiology for seizures remain a ubiquitous exclusion criterion for clinal trials in status epilepticus. Effective th…

Magnetic resonance imaging fingerprints of status epilepticus: A case-control study.

OBJECTIVE: Status epilepticus (SE) is frequently associated with peri-ictal magnetic resonance imaging (MRI) abnormalities (PMA). However, the anatomical distribution of these alterations has not been systematically studied. The aim of this study was to assess the localization patterns of PMA in patients with SE. METHODS: In this prospective case-control study, we compared the distribution and combinations of diffusion-restricted PMA to diffusion-restricted lesions caused by other neurological conditions. All patients of the SE group and the control group underwent MRI including a diffusion-w…

Acute Valproate-Induced Encephalopathy in Status Epilepticus: A Registry-Based Assessment.

BACKGROUND: Valproate-induced encephalopathy (VIE) affects between 0.1% and 2.5% of patients under long-term epilepsy treatment. Its frequency and characteristics in adults with status epilepticus (SE) is, however, unknown. OBJECTIVE: The aim of this study was to characterize the frequency and the clinico-biological characteristics of VIE in adult SE patients. METHODS: We reviewed all patients included in our institutional SE registry who were treated for an SE episode between November 2021 and February 2023 and identified 39 patients who received valproate for their SE treatment. Acute VIE …

Cefepime-Induced Neurotoxicity or Nonconvulsive Status Epilepticus (NCSE): A Controversy Revisited.

Neurotoxicity is a well-known side effect of cefepime among patients commonly present with altered mental status and typical electroencephalogram (EEG) findings of generalized periodic discharges (GPDs). Some practitioners consider this pattern as encephalopathy and often treat it with the withdrawal of cefepime only, while others are at times concerned with non-convulsive status epilepticus (NCSE) and treat it with antiseizure medications (ASMs) in addition to the withdrawal of cefepime to accelerate the recovery. We present a case series of two patients who developed cefepime-induced altered…

Early Clinical Variables Associated With Refractory Convulsive Status Epilepticus in Children.

BACKGROUND AND OBJECTIVES: The objective of this study was to determine patient-specific factors known proximate to the presentation to emergency care associated with the development of refractory convulsive status epilepticus (RSE) in children. METHODS: An observational case-control study was conducted comparing pediatric patients (1 month-21 years) with convulsive SE whose seizures stopped after benzodiazepine (BZD) and a single second-line antiseizure medication (ASM) (responsive established status epilepticus [rESE]) with patients requiring more than a BZD and a single second-line ASM to …

Pediatric status epilepticus management by Emergency Medical Services (the pSERG cohort).

PURPOSE: Delayed treatment in status epilepticus (SE) is independently associated with increased treatment resistance, morbidity, and mortality. We describe the prehospital management pathway and Emergency Medical Services (EMS) timeliness in children who developed refractory convulsive status epilepticus (RCSE). METHODS: Retrospective multicenter study in the United States using prospectively collected observational data from June 2011 to March 2020. We selected pediatric patients (one month-21 years) with RCSE initiated outside the hospital and transported to the hospital by EMS. RESULTS: …

External Capsular Hyperintensities in Wilson's Disease Presenting with Refractory Status Epilepticus.

Wilson's disease is a genetic disorder characterized by abnormal accumulation of copper in the brain, liver, eye, and kidney. Various neuropsychiatric manifestations such as dystonia, parkinsonism, choreoathetosis, tremor, ataxia, personality disorders, mood changes, psychosis, cognitive abnormalities, sleep disorders, dystonia, tremor, ataxia, and seizures are known to occur in Wilson's disease. Status epilepticus is a very rare presentation of this disease. Here, we present a case of Wilson's disease occurring in an adolescent, who presented with refractory convulsive status epilepticus. His…