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Van S, Lam V, Patel K, Humphries A, Siddiqi J. Propofol-Related Infusion Syndrome: A Bibliometric Analysis of the 100 Most-Cited Articles. Cureus 2023; 15:e46497. [PMID: 37927719 PMCID: PMC10624560 DOI: 10.7759/cureus.46497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Propofol-related infusion syndrome (PRIS) is a rare, yet life-threatening sequelae to prolonged administration of the anesthetic propofol in mechanically intubated patients. The condition is characterized by progressive multi-system organ failure and eventual mortality; of note, the predominant characteristics of PRIS involve but are not limited to cardiovascular impairment and collapse, metabolic and lactic acidosis, rhabdomyolysis, hyperkalemia, and acute renal failure. While potent or extended doses of propofol have been found to be the primary precipitating factor of this condition, others such as age, critical illness, steroid therapy, and hyperlipidemia have been discovered to play a role as well. This bibliometric analysis was done to reflect the current relevance and understanding of PRIS in recent literature. The SCOPUS database was utilized to conduct a search for articles with keywords "propofol infusion syndrome" and "propofol syndrome" from February 24, 2001, until April 16, 2023, with parameters for article title, citation number, citation per year, author, institution, publishing journal, and country of origin. PRIS was first defined in 1990, just a year after its approval by the Food and Drug Administration for use as a sedative-hypnotic. Since then, interest in PRIS slowly rose up to 13 publications per year in 2013. Seven papers on the topic were published in Critical Care Medicine, six in Neurocritical Care, and four in Anesthesia. The most common institutions were Mayo Clinic, Northeastern University, and Tufts Medical Center. To our knowledge, this is the first bibliometric analysis to evaluate the most influential publications about PRIS. A majority of the research is case-based, possibly owing to the rarity of the condition. Our research suggests that confounding factors outside the precipitating dosage of propofol may be implicated in the onset and progression of PRIS. This study could therefore bring renewed interest to the topic and lead to additional research focused on fully understanding the pathophysiology of PRIS in order to promote the development of novel diagnostics and treatment.
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Affiliation(s)
- Sophie Van
- Anesthesiology, California University of Science and Medicine, Colton, USA
| | - Vicky Lam
- Anesthesiology, California University of Science and Medicine, Colton, USA
| | - Kisan Patel
- Physical Medicine and Rehabilitation, California University of Science and Medicine, Colton, USA
| | - Andrew Humphries
- Anesthesiology, California University of Science and Medicine, Colton, USA
| | - Javed Siddiqi
- Neurological Surgery, Riverside University Health System Medical Center, Moreno Valley, USA
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Chinardet P, Gilles F, Cochet H, Chelly J, Quenot JP, Jacq G, Soulier P, Lesieur O, Beuret P, Holleville M, Bruel C, Bailly P, Sauneuf B, Sejourne C, Galbois A, Fontaine C, Perier F, Pichon N, Arrayago M, Mongardon N, Schnell D, Lascarrou JB, Convers R, Legriel S. Electrocardiographic Changes at the Early Stage of Status Epilepticus: First Insights From the ICTAL Registry. Crit Care Med 2023; 51:388-400. [PMID: 36533915 DOI: 10.1097/ccm.0000000000005768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To describe early electrocardiogram (ECG) abnormalities after status epilepticus (SE) and evaluate their association with 90-day neurological outcomes. DESIGN Retrospective analysis of a multicenter, national prospective registry between February 2018 and June 2020. SETTING Sixteen ICUs in France, IctalGroup Research Network. PATIENTS Adults with available ECG performed less than or equal to 24 hours after the onset of SE and less than or equal to 12 hours after its resolution. INTERVENTION Double-blinded review of all ECGs was performed by two independent cardiologists. ECGs were categorized as normal/abnormal and then with minor/major early ECG abnormalities according to the Novacode ECG Classification system. MEASUREMENTS AND MAIN RESULTS Among 155 critically ill patients with SE, early ECG abnormalities were encountered in 145 (93.5%), categorized as major in 91 of 145 (62.8%). In addition to sinus tachycardia, the main abnormalities were in the ST segment (elevation [16.6%] or depression [17.9%]) or negative T waves (42.1%). Major early ECG abnormalities were significantly associated with respiratory distress and sinus tachycardia at the scene and hyperlactatemia at ICU admission. By multivariable analysis, three variables were significantly associated with 90-day poor outcome: age, preexisting ultimately fatal comorbidity, and cerebral insult as the cause of SE. Early major ECG abnormalities were not independently associated with 90-day functional outcome. CONCLUSIONS In our study, early ECG abnormalities in the acute phase of SE were frequent, often unrecognized and were associated with clinical and biological stigma of hypoxemia. Although they were not independently associated with 90-day functional outcome, ECG changes at the early stage of SE should be systematically evaluated. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT03457831 .
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Affiliation(s)
- Paul Chinardet
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
| | - Floriane Gilles
- Cardiology Department, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
| | - Helene Cochet
- Cardiology Department, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
| | - Jonathan Chelly
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, Toulon, France
| | - Jean-Pierre Quenot
- IctalGroup, Le Chesnay, France
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Gwenaelle Jacq
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
- UVSQ, INSERM, University Paris-Saclay, CESP, Team «PsyDev», Villejuif, France
| | - Pauline Soulier
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Marc Jacquet Hospital, Melun, France
| | - Olivier Lesieur
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Saint-Louis Hospital, La Rochelle, France
| | - Pascal Beuret
- IctalGroup, Le Chesnay, France
- Department of Intensive and Continuous Care, Roanne Hospital, Roanne, France
| | - Mathilde Holleville
- IctalGroup, Le Chesnay, France
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, Paris, France
| | - Cedric Bruel
- IctalGroup, Le Chesnay, France
- Saint Joseph Hospital, Medical-Surgical Intensive Care Unit, Paris, France
| | - Pierre Bailly
- IctalGroup, Le Chesnay, France
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, Brest Cedex, France
| | - Bertrand Sauneuf
- IctalGroup, Le Chesnay, France
- Cotentin Public Hospital Center, General Intensive Care Unit, Cherbourg-en-Cotentin, France
| | - Caroline Sejourne
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Hôpital de Béthune, Beuvry, France
| | - Arnaud Galbois
- IctalGroup, Le Chesnay, France
- Department of Polyvalent Intensive Care Unit, Ramsay Générale de Santé, Claude Galien Private Hospital, Quincy-sous-Sénart, France
| | - Candice Fontaine
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
| | - François Perier
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
| | - Nicolas Pichon
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Centre Hospitalier de Brive, Brive-La-Gaillarde, France
| | - Marine Arrayago
- IctalGroup, Le Chesnay, France
- Department of Intensive Care, Cannes Hospital, Cannes, France
| | - Nicolas Mongardon
- IctalGroup, Le Chesnay, France
- Henri Mondor Teaching Hospital, Service D'anesthésie-Réanimation Chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Univ Paris Est Créteil, Faculté de Santé, Créteil, France
- U955-IMRB, Equipe 03 "Pharmacologie Et Technologies Pour Les Maladies Cardiovasculaires (PROTECT)," Inserm, Univ Paris Est Créteil (UPEC), Ecole Nationale Vétérinaire d'Alfort (EnVA), Maisons-Alfort, France
| | - David Schnell
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Centre Hospitalier d'Angoulême, Angoulême, France
| | - Jean-Baptiste Lascarrou
- IctalGroup, Le Chesnay, France
- Intensive Care Unit, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes Cedex, France
| | - Raphaële Convers
- Cardiology Department, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
| | - Stephane Legriel
- Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, Le Chesnay Cedex, France
- IctalGroup, Le Chesnay, France
- UVSQ, INSERM, University Paris-Saclay, CESP, Team «PsyDev», Villejuif, France
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Reindl C, Madžar D, Hamer HM. [Status epilepticus-Detection and treatment in the intensive care unit]. DER NERVENARZT 2023; 94:120-128. [PMID: 36534176 DOI: 10.1007/s00115-022-01418-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
Status epilepticus is characterized by persistent or repetitive seizures which, without successful treatment, can lead to neuronal damage, neurological deficits and death of the patient.While status epilepticus with motor symptoms can usually be clinically diagnosed, nonconvulsive status epilepticus is often clinically overlooked due to its ambiguous semiology, so that electroencephalography (EEG) recording is necessary. The treatment of status epilepticus is performed in four treatment steps, whereby a difficult to treat status epilepticus is present from the third step at the latest and intensive medical care of the patient is necessary. Timely initiation of treatment and sufficient dosage of anticonvulsive medication are decisive for the success of treatment. There is little evidence for the "late" stages of treatment. Intensive medical measures pose the risk of complications that worsen the prognosis. Especially in nonconvulsive status epilepticus, the use of anesthetics must be weighed against possible complications of mechanical ventilation.
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Affiliation(s)
- Caroline Reindl
- Neurologische Klinik, Epilepsiezentrum, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland.
| | - Dominik Madžar
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - Hajo M Hamer
- Neurologische Klinik, Epilepsiezentrum, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
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Status Epilepticus. Crit Care Clin 2023; 39:87-102. [DOI: 10.1016/j.ccc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Swarnalingam E, Woodward K, Esser M, Jacobs J. Management and prognosis of pediatric status epilepticus. ZEITSCHRIFT FÜR EPILEPTOLOGIE 2022. [DOI: 10.1007/s10309-022-00538-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background
Pediatric status epilepticus is a neurological emergency with the potential for severe developmental and neurological consequences. Prompt diagnosis and management are necessary.
Objectives
To outline the existing best available evidence for managing pediatric and neonatal status epilepticus, in the light of emerging randomized controlled studies. We also focus on short and long-term prognoses.
Materials and methods
This is a systematic overview of the existing literature.
Results
Status epilepticus, its treatment, and prognosis are usually based on the continuation of seizure activity at 5 and 30 min. Refractory and super-refractory status epilepticus further complicates management and requires continuous EEG monitoring with regular reassessment and adjustment of therapy. Benzodiazepines have been accepted as the first line of treatment on the basis of reasonable evidence. Emerging randomized controlled trials demonstrate equal efficacy for parenterally administered phenytoin, levetiracetam, and valproic acid as second-line agents. Beyond this, the evidence for third-line options is sparse. However, encouraging evidence for midazolam and ketamine exists with further data required for immunological, dietary, and surgical interventions.
Conclusion
Our overview of the management of pediatric and neonatal status epilepticus based on available evidence emphasizes the need for evidence-based guidelines to manage status epilepticus that fails to respond to second-line treatment.
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Vergara Aguilar JP, Palacios Sánchez E, Dueñas Garcia F, Cuesta Gutiérrez A, Ortega Hernández L, Vera Vega O, Leal Castaño L, Alzate Granados JP. Conocimiento de los residentes de especialidades médico-quirúrgicas en Colombia acerca del estado epiléptico. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: el estado epiléptico es una emergencia con serias implicaciones a nivel social y económico, cuando no se maneja de manera adecuada puede llevar a la muerte. Debe abordarse por el primer especialista que tenga contacto con el paciente. En Colombia no hay estudios acerca de la adherencia a guías de práctica clínica. Objetivo: evaluar cuál es el conocimiento acerca del estado epiléptico en residentes de especialidades médico quirúrgicas en Colombia. Métodos: estudio de corte transversal descriptivo. Se aplicó una encuesta por medio de formulario google, diseñada con base en las guías de práctica clínica rutinaria para el manejo de esta patología. Resultados: respondieron la encuesta 76 residentes de neurología, medicina interna, medicina de urgencias y cuidado crítico, la edad más frecuente fue 26 a 31 años, con una relación hombre mujer de 46/54%. Discusión: las preguntas concernientes a las definiciones operativas y a los tiempos de acción fueron las que tuvieron una mejor consistencia al responderse, hay una importante falencia en la selección y uso de medicamentos anticrisis en el contexto del estado epiléptico, por lo que es importante fortalecer la educación médica en éstos aspectos académicos.
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Ibrahim A, Megahed A, Salem A, Zekry O. Impact of Cardiac Injury on the Clinical Outcome of Children with Convulsive Status Epilepticus. CHILDREN 2022; 9:children9020122. [PMID: 35204843 PMCID: PMC8869812 DOI: 10.3390/children9020122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 11/16/2022]
Abstract
Objectives: the aim of this study was to determine the impact of cardiac injury on clinical profile, cardiac evaluation and outcome in patients hospitalized with convulsive status epilepticus (CSE). Materials and methods: this prospective observational study included 74 children with CSE. Cardiac injury was evaluated and defined using combination of cardiac troponin, electrocardiography (ECG) and echocardiography. Clinical outcome and mortality rates were compared in patients with and without cardiac injury. Results: A total of 74 patients with CSE were included in the study. Thirty-six (48.6%) patients demonstrated markers of cardiac injury. ECG changes occurred in 45.9% and echocardiographic signs of left ventricular systolic and diastolic dysfunction reported in 5.4% and 8.1%, respectively. The mean length of hospital stays and need for ICU admission were significantly higher in patients with cardiac injury compared to others. One third of patients with cardiac injury needed mechanical ventilation and this was significantly higher than patients without (p = 0.042). hypotension and/or shock developed in 25% of cardiac injury patients and most of them required inotropic support; this was significantly higher than others without markers of cardiac injury. The overall mortality in cardiac injury group was higher (13.9% vs. 2.6%); however, this difference was not statistically significant. Conclusion: Markers of cardiac injury were common and associated with poor clinical outcome and higher risk of mortality in patients with CSE, so extensive routine cardiovascular evaluation is essential in these patients.
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Affiliation(s)
- Ahmed Ibrahim
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt; (A.M.); (O.Z.)
- Correspondence: ; Tel.: +20-1225951409
| | - Ahmed Megahed
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt; (A.M.); (O.Z.)
| | - Ahmed Salem
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt;
| | - Osama Zekry
- Department of Pediatrics, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt; (A.M.); (O.Z.)
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First-Response ABCDE Management of Status Epilepticus: A Prospective High-Fidelity Simulation Study. J Clin Med 2022; 11:jcm11020435. [PMID: 35054129 PMCID: PMC8780943 DOI: 10.3390/jcm11020435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
Respiratory infections following status epilepticus (SE) are frequent, and associated with higher mortality, prolonged ICU stay, and higher rates of refractory SE. Lack of airway protection may contribute to respiratory infectious complications. This study investigates the order and frequency of physicians treating a simulated SE following a systematic Airways-Breathing-Circulation-Disability-Exposure (ABCDE) approach, identifies risk factors for non-adherence, and analyzes the compliance of an ABCDE guided approach to SE with current guidelines. We conducted a prospective single-blinded high-fidelity trial at a Swiss academic simulator training center. Physicians of different affiliations were confronted with a simulated SE. Physicians (n = 74) recognized SE and performed a median of four of the five ABCDE checks (interquartile range 3–4). Thereof, 5% performed a complete assessment. Airways were checked within the recommended timeframe in 46%, breathing in 66%, circulation in 92%, and disability in 96%. Head-to-toe (exposure) examination was performed in 15%. Airways were protected in a timely manner in 14%, oxygen supplied in 69%, and antiseizure drugs (ASDs) administered in 99%. Participants’ neurologic affiliation was associated with performance of fewer checks (regression coefficient −0.49; p = 0.015). We conclude that adherence to the ABCDE approach in a simulated SE was infrequent, but, if followed, resulted in adherence to treatment steps and more frequent protection of airways.
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Dericioglu N, Ayvacioglu Cagan C, Sokmen O, Arsava EM, Topcuoglu MA. Frequency and Types of Complications Encountered in Patients With Nonconvulsive Status Epilepticus in the Neurological ICU: Impact on Outcome. Clin EEG Neurosci 2021; 54:265-272. [PMID: 34714180 DOI: 10.1177/15500594211046722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. The frequency and types of complications in patients with nonconvulsive status epilepticus (NCSE) who are followed up in the intensive care unit (ICU), and the impact of these complications on outcome are not well-known. We investigated the complications and their effects on prognosis in NCSE patients. Methods. After reviewing the video-EEG monitoring (VEEGM) reports of all the consecutive patients who were followed up in our ICU between 2009 and 2019, we identified two groups of patients: 1-patients with NCSE (study group) and 2-patients who underwent VEEGM for possible NCSE but did not have ictal recordings (no-NCSE group). Electronic health records were reviewed to identify demographic and clinical data, duration of ICU care, medical and surgical complications, pharmacologic treatment, and outcome. These parameters were compared statistically between the groups. We also investigated the parameters affecting prognosis at discharge. Results. Thirty-two patients with NCSE comprised the study group. Infection developed in 84%. More than half were intubated, had tracheostomy or percutaneous endoscopic gastrostomy application. Refractory NCSE was associated with significantly more frequent complications and worse outcome. There was a higher tendency of infections in the study group (P = .059). Higher organ failure scores and prolonged stay in ICU predicted worse outcome (P < .05). Conclusion. The frequency of complications in patients with NCSE who are cared for in the ICU is considerable. Most of the complications are similar to the other patients in ICU, except for the higher frequency of infections. Increased physician awareness about modifiable parameters and timely interventions might help improve prognosis.
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Abstract
Context Refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE) are neurological emergencies with considerable mortality and morbidity. In this paper, we provide an overview of causes, evaluation, treatment, and consequences of RSE and SRSE, reflecting the lack of high-quality evidence to inform therapeutic approach. Sources This is a narrative review based on personal practice and experience. Nevertheless, we searched MEDLINE (using PubMed and OvidSP vendors) and Cochrane central register of controlled trials, using appropriate keywords to incorporate recent evidence. Results Refractory status epilepticus is commonly defined as an acute convulsive seizure that fails to respond to two or more anti-seizure medications including at least one nonbenzodiazepine drug. Super-refractory status epilepticus is a status epilepticus that continues for ≥24 hours despite anesthetic treatment, or recurs on an attempted wean of the anesthetic regimen. Both can occur in patients known to have epilepsy or de novo, with increasing recognition of autoimmune and genetic causes. Electroencephalography monitoring is essential to monitor treatment response in refractory/super-refractory status epilepticus, and to diagnose non-convulsive status epilepticus. The mainstay of treatment for these disorders includes anesthetic infusions, primarily midazolam, ketamine, and pentobarbital. Dietary, immunological, and surgical treatments are viable in selected patients. Management is challenging due to multiple acute complications and long-term adverse consequences. Conclusions We have provided a synopsis of best practices for diagnosis and management of refractory/superrefractory status epilepticus and highlighted the lack of sufficient high-quality evidence to drive decision making, ending with a brief foray into avenues for future research.
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Affiliation(s)
- Debopam Samanta
- Child Neurology Division, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Lisa Garrity
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ravindra Arya
- Comprehensive Epilepsy Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; USA. Correspondence to: Dr Ravindra Arya, Division of Neurology, Cincinnati Children's Hospital Medical Center, MLC 2015, 3333 Burnet Avenue, Cincinnati, Ohio, 45229 USA.
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Abstract
Patients with acute neurologic disease often also have evidence of cardiac dysfunction. The cardiac dysfunction may result in a number of clinical signs including abnormal EKG changes, variations in blood pressure, development of cardiac arrhythmias, release of cardiac biomarkers, and reduced ventricular function. Although typically reversible, these cardiac complications are important to recognize as they are associated with increased morbidity and mortality. In this chapter, we discuss the suspected pathophysiology, clinical presentation, and management of the cardiac dysfunction that occur as a consequence of different types of acute neurologic illness.
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Villalpando-Vargas F, Medina-Ceja L, Santerre A, Enciso-Madero EA. The anticonvulsant effect of sparteine on pentylenetetrazole-induced seizures in rats: a behavioral, electroencephalographic, morphological and molecular study. J Mol Histol 2020; 51:503-518. [PMID: 32729055 DOI: 10.1007/s10735-020-09899-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/20/2020] [Indexed: 02/01/2023]
Abstract
Abnormal synchronous activity in neurons generates epileptic seizures. Antiepileptic drugs (AEDs) are effective in 70% of patients, but this percentage is drastically lower in developing countries. Sparteine is a quinolizidine alkaloid synthesized from most Lupine species and has a probable anticonvulsive effect. For this reason, the objective of the present work was to study the anticonvulsant effect of sparteine using a dose-effect curve and to determine its effectiveness against seizures using behavioral, electroencephalographic, morphological and molecular data. Wistar rats were grouped into control [saline solution (0.9%), pentylenetetrazole (90 mg/kg), and sparteine (13, 20 and 30 mg/kg), intraperitoneal (i.p.)] and experimental (sparteine + pentylenetetrazole) groups. The rats were implanted with surface electrodes to register electrical activity, and convulsive behavior was evaluated according to Velisek's scale. The rats were perfused to obtain brain slices for cresyl violet staining and cellular density quantification as well as for immunohistochemistry for NeuN and GFAP. Other animals were used to determine the hippocampal mRNA expression of the M2 and M4 acetylcholine receptors by qPCR. Sparteine exhibited a better anticonvulsant effect at a dose of 30 mg/kg (i.p.) than at the other doses used. This anticonvulsant effect was characterized by a decrease in the severity of convulsive behavior, 100% survival, an inhibitory effect on epileptiform activity 75 min after pentylenetetrazole administration, and the conservation of the cellular layers of CA1, CA3 and the dentate gyrus (DG); however, astrogliosis was observed after 30 mg/kg sparteine treatment. In addition, sparteine treatment increased the mRNA expression of the M4 receptor three hours after administration. According to our findings, the effective dose of sparteine as an anticonvulsant agent by i.p. injection is 30 mg/kg. The astrogliosis that was observed after sparteine administration may be a compensatory mechanism to diminish excitability and maintain neuronal homeostasis, possibly through redistributing potassium and glutamate. The increase in the mRNA expression of the M4 receptor may suggest the participation of the M4 receptor in the anticonvulsive effect of sparteine, as the activation of this receptor may inhibit acetylcholine release and facilitate the subsequent release of GABA. However, the precise mechanisms by which sparteine produces these effects are not known, and therefore, further experiments are necessary.
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Affiliation(s)
- Fridha Villalpando-Vargas
- Laboratory of Neurophysiology, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Camino Ing. R. Padilla Sánchez 2100, Las Agujas, Nextipac, CP 45110, Zapopan, Jalisco, Mexico
| | - Laura Medina-Ceja
- Laboratory of Neurophysiology, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Camino Ing. R. Padilla Sánchez 2100, Las Agujas, Nextipac, CP 45110, Zapopan, Jalisco, Mexico.
| | - Anne Santerre
- Laboratory of Molecular Biomarkers in Biomedicine and Ecology, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Zapopan, Jalisco, Mexico
| | - Edgar A Enciso-Madero
- Laboratory of Neurophysiology, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Camino Ing. R. Padilla Sánchez 2100, Las Agujas, Nextipac, CP 45110, Zapopan, Jalisco, Mexico
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Outin H, Gueye P, Alvarez V, Auvin S, Clair B, Convers P, Crespel A, Demeret S, Dupont S, Engels JC, Engrand N, Freund Y, Gelisse P, Girot M, Marcoux MO, Navarro V, Rossetti A, Santoli F, Sonneville R, Szurhaj W, Thomas P, Titomanlio L, Villega F, Lefort H, Peigne V. Recommandations Formalisées d’Experts SRLF/SFMU : Prise en charge des états de mal épileptiques en préhospitalier, en structure d’urgence et en réanimation dans les 48 premières heures (A l’exclusion du nouveau-né et du nourrisson). ANNALES FRANCAISES DE MEDECINE D URGENCE 2020. [DOI: 10.3166/afmu-2020-0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La Société de réanimation de langue française et la Société française de médecine d’urgence ont décidé d’élaborer de nouvelles recommandations sur la prise en charge de l’état mal épileptique (EME) avec l’ambition de répondre le plus possible aux nombreuses questions pratiques que soulèvent les EME : diagnostic, enquête étiologique, traitement non spécifique et spécifique. Vingt-cinq experts ont analysé la littérature scientifique et formulé des recommandations selon la méthodologie GRADE. Les experts se sont accordés sur 96 recommandations. Les recommandations avec le niveau de preuve le plus fort ne concernent que l’EME tonico-clonique généralisé (EMTCG) : l’usage des benzodiazépines en première ligne (clonazépam en intraveineux direct ou midazolam en intramusculaire) est recommandé, répété 5 min après la première injection (à l’exception du midazolam) en cas de persistance clinique. En cas de persistance 5 min après cette seconde injection, il est proposé d’administrer la seconde ligne thérapeutique : valproate de sodium, (fos-)phénytoïne, phénobarbital ou lévétiracétam. La persistance avérée de convulsions 30 min après le début de l’administration du traitement de deuxième ligne signe l’EMETCG réfractaire. Il est alors proposé de recourir à un coma thérapeutique au moyen d’un agent anesthésique intraveineux de type midazolam ou propofol. Des recommandations spécifiques à l’enfant et aux autres EME sont aussi énoncées.
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Orlandi N, Giovannini G, Rossi J, Cioclu MC, Meletti S. Clinical outcomes and treatments effectiveness in status epilepticus resolved by antiepileptic drugs: A five-year observational study. Epilepsia Open 2020; 5:166-175. [PMID: 32524042 PMCID: PMC7278543 DOI: 10.1002/epi4.12383] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 02/09/2020] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate clinical outcomes and treatment effectiveness of status epilepticus finally resolved by nonbenzodiazepine antiepileptic drugs (AEDs). Methods All consecutive SE episodes observed from September 1, 2013, to September 1, 2018, and resolved by AEDs were considered. Diagnosis and classification of SE followed the 2015 ILAE proposal. Nonconvulsive status (NCSE) diagnosis was confirmed according to the Salzburg EEG criteria. The modified Rankin Scale and deaths at 30 days from onset were used to evaluate outcomes. Results A total of 277 status episodes (mean age 71 years; 61% female) were treated and resolved by antiepileptic drugs after 382 treatment trials. 68% of the SE resolved after AED use as first/second treatment line, while subsequent trials with AEDs gave an additional 32% resolution. A return to baseline conditions was observed in 48% of the patients, while overall mortality was 19% without significant changes across the study years. Mortality was higher in NCSE than in convulsive SE (22.5% vs 12.9%; P < .05), while mortality did not differ in SE episodes resolved by a first/second AED trial (17.2%) versus SE resolved by successive treatment trials (18.9%). The resolution rate of intravenous AEDs was 82% for valproate, 77% for lacosamide, 71% for phenytoin, and 62% for levetiracetam. No significant differences were found in head-to-head comparison, but for the valproate-levetiracetam one that was related to NCSE episodes in which valproate resulted to be effective in 86% of the trials while levetiracetam in 62% (P < .002). Significance A high short-term mortality, stable over time, was observed in SE despite resolution of seizures, especially in SE with nonconvulsive semiology. Comparative AED efficacy showed no significant differences except for higher resolution rate for valproate versus levetiracetam in NCSE.
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Affiliation(s)
- Niccolò Orlandi
- Neurology Unit OCB Hospital Azienda Ospedaliera-Universitaria Modena Italy.,Department of Biomedical, Metabolic and Neural Science University of Modena and Reggio Emilia Modena Italy
| | - Giada Giovannini
- Neurology Unit OCB Hospital Azienda Ospedaliera-Universitaria Modena Italy.,Department of Biomedical, Metabolic and Neural Science University of Modena and Reggio Emilia Modena Italy
| | - Jessica Rossi
- Neurology Unit OCB Hospital Azienda Ospedaliera-Universitaria Modena Italy.,Department of Biomedical, Metabolic and Neural Science University of Modena and Reggio Emilia Modena Italy
| | - Maria Cristina Cioclu
- Neurology Unit OCB Hospital Azienda Ospedaliera-Universitaria Modena Italy.,Department of Biomedical, Metabolic and Neural Science University of Modena and Reggio Emilia Modena Italy
| | - Stefano Meletti
- Neurology Unit OCB Hospital Azienda Ospedaliera-Universitaria Modena Italy.,Department of Biomedical, Metabolic and Neural Science University of Modena and Reggio Emilia Modena Italy
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Abstract
Blood Markers of Cardiac Stress After Generalized Convulsive Seizures. Nass RD, Motloch LJ, Paar V, Lichtenauer M, Baumann J, Zur B, Hoppe UC, Holdenrieder S, Elger CE, Surges R. Epilepsia. 2019;60(2):201-210. doi:10.1111/epi.14637. Epub 2019 Jan 15. PMID: 30645779 Objective: Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS. METHODS Adult patients with refractory epilepsy who underwent video-electroencephalography monitoring along with simultaneous one-lead electrocardiography recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitivity troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Peri-ictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals (QTc). RESULTS Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than 2-fold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 (10%) of 30 patients and 6 (26%) of 23 patients, respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient. SIGNIFICANCE The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. Soluble urokinase plasminogen activator receptor may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS but specificity needs to be tested.
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Gofton TE, Wong N, Hirsch LJ, Hocker SE. Communication Challenges: A Spotlight on New-Onset Refractory Status Epilepticus. Mayo Clin Proc 2019; 94:857-863. [PMID: 30935709 DOI: 10.1016/j.mayocp.2018.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/04/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
New-onset refractory status epilepticus (NORSE) is a rare, potentially devastating condition that occurs abruptly in previously healthy patients of any age but most commonly in children and young adults. It has an unpredictable clinical course requiring immediate, often prolonged, critical care support with multiple specialists involved and frequently results in severe life-altering sequelae or death. Communication in NORSE is challenging because its etiology in a given patient is initially unknown (and often remains so), the clinical course and outcome are unpredictable, and many health care team members are involved in the care of a patient. We address the communication challenges seen in NORSE through proactive communication on 3 levels: (1) in the shared decision-making process with the family, (2) within an individual hospital, and (3) across institutions. Intentional organizational change and enhanced information dissemination may help break down barriers to effective communication. Key initiatives for enhancing information dissemination in NORSE are (1) the identification of a most responsible physician to integrate information from subspecialties, to communicate frequently and candidly with the family, and to provide continuity of care over a prolonged period of time and (2) the early involvement of palliative care services alongside ongoing therapies with curative intent to support families and the medical team in decision making and communication.
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Affiliation(s)
- Teneille E Gofton
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | | | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT
| | - Sara E Hocker
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, Rochester, MN
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Arya R, Rotenberg A. Dietary, immunological, surgical, and other emerging treatments for pediatric refractory status epilepticus. Seizure 2019; 68:89-96. [DOI: 10.1016/j.seizure.2018.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023] Open
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Hocker S. Anesthetic drugs for the treatment of status epilepticus. Epilepsia 2018; 59 Suppl 2:188-192. [PMID: 30159894 DOI: 10.1111/epi.14498] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 11/27/2022]
Abstract
Worsening pharmacoresistance to antiseizure drugs is common with ongoing excitotoxic neuronal and systemic injury. Early initiation of anesthetic drugs in refractory status epilepticus (RSE) may halt these processes while allowing time for treatment targeting the cause of the seizures. Current guidelines support the use of anesthetic drugs as the third line pharmacologic therapy in generalized convulsive status epilepticus but do not clearly define the indications for these drugs in other types of status epilepticus. There is wide practice variation in choice of third line therapy for RSE, but there is overall consensus that anesthetics should be initiated earlier in generalized convulsive status epilepticus than in nonconvulsive forms. More recently, doubt has been cast on the appropriateness of anesthetic treatment of RSE following a series of studies associating their use with higher mortality and morbidity. This suggests that efforts should focus on determination of who benefits most, optimal use, and prevention of refractoriness. The risk-benefit ratio of anesthetic use is discussed, with specific indications proposed. In addition, anesthetic dosing, supportive neurocritical care, electroencephalogram suppression target, and weaning of anesthesia are reviewed.
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Affiliation(s)
- Sara Hocker
- Department of Neurology, Division of Critical Care, Mayo Clinic, Rochester, MN, USA
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Abstract
Status epilepticus (SE) is a medical emergency characterized by uncontrolled, prolonged seizures with rapid and widespread neuronal damage. Patients that suffer from longer episodes of SE are more likely to have poorer clinical outcomes and a higher cost of healthcare. Understanding novel molecular mechanisms that regulate inhibitory and excitatory neurotransmission that initiate SE and the necessary medical infrastructure to stop SE could help identify targets for early intervention. Intranasal administration of benzodiazepines may shorten the time between initiation and cessation of seizures when compared to other routes of administration. Current pharmaceutical administration guidelines are appropriate for sporadic incidences of SE, but exploring other approaches is necessary to prepare for situations involving multiple patients outside of a hospital, such as a massive chemical weapons attack. Intranasal drug delivery helps to circumvent the blood–brain barrier and offers a noninvasive way to quickly administer drugs in settings that require an immediate response, such as nerve agent exposure. In addition, examining the intranasal delivery of new drugs, such as nanotherapeutics, may lead to more effective, noninvasive, scalable, and portable methods of treating SE.
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Kämppi L, Ritvanen J, Strbian D, Mustonen H, Soinila S. Complication Burden Index-A tool for comprehensive evaluation of the effect of complications on functional outcome after status epilepticus. Epilepsia 2018; 59 Suppl 2:176-181. [DOI: 10.1111/epi.14491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Leena Kämppi
- Clinical Neurosciences, Neurology; Department of Neurology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Jaakko Ritvanen
- Clinical Neurosciences, Neurology; Department of Neurology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Daniel Strbian
- Clinical Neurosciences, Neurology; Department of Neurology; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Harri Mustonen
- Department of Surgery; University of Helsinki and Helsinki University Central Hospital; Helsinki Finland
| | - Seppo Soinila
- Division of Clinical Neurosciences/General Neurology; Department of Neurology; Turku University Hospital; University of Turku; Turku Finland
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Tiamkao S, Saybungkla P, Sirikarn P, Sawanyawisuth K. Predictors of long-term mortality in status epilepticus. Epilepsy Behav 2018; 84:114-117. [PMID: 29778845 DOI: 10.1016/j.yebeh.2018.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND There were several studies that have reported on the long-term mortality rate of status epilepticus (SE). However, these studies were conducted mainly in Western countries using small study populations. This study aimed to evaluate predictors for long-term mortality in SE using the Thai national healthcare database. METHODS This study was conducted using the Thai national Universal Health Coverage (UC) database. The eligibility criteria for this study were that all patients were diagnosed with SE and had been admitted to any hospital between 2005 and 2015. Mortality was defined at discharge and at one, three, five, and 10 years. All eligible patients were categorized as either having survived or having died. The mortality rates were calculated at one, three, five, and 10 years. Factors associated with mortality were analyzed using backward multivariate Cox proportional hazard regression analysis. Kaplan-Meier was performed to estimate the survival rate. RESULTS During the study period, there were 21,732 patients with SE admitted who met the study criteria. The total observation time was 85,821.28 person-years. Of the patients enrolled, 3642 (or 4.24 per 100 person-years [95% confidence interval (CI): 4.11-4.38]) died. Factors positively associated with mortality in patients with SE were central nervous system (CNS) infection, cancer, heart diseases, chronic renal failure, septicemia, pneumonia, respiratory failure, acute renal failure, and shock. Heart diseases had the highest adjusted hazard ratio at 2.69 (95% CI: 2.47-2.93). Two factors were negatively related with SE mortality: hypertension and urinary tract infection. CONCLUSION Long-term mortality in patients with SE had both positive and negative predictors in the national database.
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Affiliation(s)
- Somsak Tiamkao
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand.
| | - Pawinee Saybungkla
- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand; Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Srinagarind Hospital, Faculty of Medicine, Khon kaen University, Khon Kaen, Thailand; Program in Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine and Ambulatory Medicine Research Group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand
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- Integrated Epilepsy Research Group, Khon Kaen University, Khon Kaen, Thailand
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Abstract
PURPOSE OF REVIEW Status epilepticus (SE) is a multisystem disorder. Initially, complications of a massive catecholamine release followed by the side effects of medical therapies, impact patients' outcomes. The aim of this article is to provide an updated summary of the systemic complications following SE. RECENT FINDINGS In recent years, the importance of the multifaceted nature of SE and its relationship with clinical outcomes has been increasingly recognized. The cumulative systemic effects of prolonged seizures and their treatment contribute to morbidity and mortality in this condition. Most systemic complications after SE are predictable. Anticipating their occurrence and respecting a number of simple guidelines may improve the prognosis of these patients.
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Affiliation(s)
- Maximiliano A Hawkes
- Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Sara E Hocker
- Department of Neurology, Division of Critical Care Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
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Kim HK, Hwang IG, Koh IS, Kim DW. Incidence and risk factors of hypotension after intravenous fosphenytoin administration. J Clin Pharm Ther 2017; 42:561-566. [DOI: 10.1111/jcpt.12537] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 03/29/2017] [Indexed: 11/30/2022]
Affiliation(s)
- H. K. Kim
- Department of Neurology; National Medical Center; Seoul Korea
| | - I. G. Hwang
- Department of Neurology; National Medical Center; Seoul Korea
| | - I.-S. Koh
- Department of Neurology; National Medical Center; Seoul Korea
| | - D. W. Kim
- Department of Neurology; Konkuk University School of Medicine; Seoul Korea
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Abstract
Status epilepticus is a neurologic and medical emergency manifested by prolonged seizure activity or multiple seizures without return to baseline. It is associated with substantial medical cost, morbidity, and mortality. There is a spectrum of severity dependent on the type of seizure, underlying pathology, comorbidities, and appropriate and timely medical management. This chapter discusses the evolving definitions of status epilepticus and multiple patient and clinical factors which influence outcome. The pathophysiology of status epilepticus is reviewed to provide a better understanding of the mechanisms which contribute to status epilepticus, as well as the potential long-term effects. The clinical presentations of different types of status epilepticus in adults are discussed, with emphasis on the hospital course and management of the most dangerous type, generalized convulsive status epilepticus. Strategies for the evaluation and management of status epilepticus are provided based on available evidence from clinical trials and recommendations from the Neurocritical Care Society and the European Federation of Neurological Societies.
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Affiliation(s)
- M Pichler
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - S Hocker
- Division of Critical Care Neurology, Mayo Clinic, Rochester, MN, USA.
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Villalpando-Vargas F, Medina-Ceja L. Sparteine as an anticonvulsant drug: Evidence and possible mechanism of action. Seizure 2016; 39:49-55. [PMID: 27262285 DOI: 10.1016/j.seizure.2016.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/12/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022] Open
Abstract
Sparteine is a quinolizidine alkaloid extracted from Lupinus that has numerous pharmacological properties both in humans and animal models. In the central nervous system, sparteine reduces locomotor activity, has light analgesic effects, also has no effects on short-term memory or spatial learning and does not induce changes in behavior or electroencephalographic (EEG) activity. However, the anticonvulsant profile of sparteine is not fully characterized in experimental animals and there are no data in humans. Therefore, the present review focuses on the experimental evidence supporting the anticonvulsant action of sparteine in models of acute seizures and status epilepticus (SE), as well as its possible mechanisms of action. The evidence that supports the anticonvulsant effect of (-)-Sparteine sulfate includes the inhibition of seizures induced by maximal electro-stimulation, a delay in the onset of convulsive behavior and the prolongation of survival time in mice treated with pentylenetetrazole (PTZ). Additionally, sparteine delays the onset of convulsive behavior and decreases the severity and mortality of rats treated with PTZ and pilocarpine. Sparteine decreases amplitude and frequency or blocks the epileptiform activity induced by PTZ, pilocarpine and kainic acid. Sparteine may decrease hyperexcitability through the activation of the M2 and M4 subtypes of mAChRs, which is a probable mechanism of action that together with its systemic effects may favor its anticonvulsant effects against seizures and SE.
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Affiliation(s)
- Fridha Villalpando-Vargas
- Laboratory of Neurophysiology and Neurochemistry, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Jalisco, Mexico
| | - Laura Medina-Ceja
- Laboratory of Neurophysiology and Neurochemistry, Department of Cellular and Molecular Biology, CUCBA, University of Guadalajara, Jalisco, Mexico.
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Famularo G. Status epilepticus and type 2 myocardial infarction. Am J Emerg Med 2016; 34:1735.e3-4. [PMID: 26786518 DOI: 10.1016/j.ajem.2015.12.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 12/18/2015] [Accepted: 12/20/2015] [Indexed: 11/24/2022] Open
Affiliation(s)
- Giuseppe Famularo
- Department of Emergency Medicine, San Camillo Hospital, Rome, Italy.
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Lionel KR, Hrishi AP. Seizures - just the tip of the iceberg: Critical care management of super-refractory status epilepticus. Indian J Crit Care Med 2016; 20:587-592. [PMID: 27829714 PMCID: PMC5073773 DOI: 10.4103/0972-5229.192047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Super-refractory status epilepticus (SRSE) is defined as status epilepticus (SE) that continues or recurs 24 h or more after the onset of anesthetic therapy, including those cases where SE recurs on the reduction or withdrawal of anesthesia. Although SRSE is a rare clinical problem, it is associated with high mortality and morbidity rates. This article reviews the treatment approaches and the systemic complications commonly encountered in patients with SRSE. As evident in our search of literature, therapy for SRSE and its complications have been based on clinical reports and expert opinions since there is a lack of controlled and randomized trials. Even though this complex condition starts as a neurological disorder, because of the associated systemic complications, it can be considered as a multisystem disorder requiring scrupulous attention and deliberate efforts to prevent, detect, and treat these systemic effects. We have critically reviewed the intensive care management for SRSE per se as well as its associated systemic complications. We believe that a good recovery can occur even after prolonged and severe SRSE as long as the systemic complications are detected early and managed appropriately.
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Affiliation(s)
- Karen Ruby Lionel
- Department of Neuroanesthesia and Neurocritical Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ajay Prasad Hrishi
- Department of Neuroanesthesia and Neurocritical Care, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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