Surgical correction of scoliosis in patients with generalized seizures. Risk of vertebral body fracture

Acute Systemic Complications of Convulsive Status Epilepticus-A Systematic Review

OBJECTIVES

Status epilepticus is a neurologic emergency with high morbidity and mortality requiring neurointensive care and treatment of systemic complications. This systematic review compiles the current literature on acute systemic complications of generalized convulsive status epilepticus in adults and their immediate clinical impact along with recommendations for optimal neurointensive care.

DATA SOURCES

We searched PubMed, Medline, Embase, and the Cochrane library for articles published between 1960 and 2016 and reporting on systemic complications of convulsive status epilepticus.

STUDY SELECTION

All identified studies were screened for eligibility by two independent reviewers.

DATA EXTRACTION

Key data were extracted using standardized data collection forms.

DATA SYNTHESIS

Thirty-two of 3,046 screened articles were included. Acute manifestations and complications reported in association with generalized convulsive status epilepticus can affect all organ systems fueling complex cascades and multiple organ interactions. Most reported complications result from generalized excessive muscle contractions that increase body temperature and serum potassium levels and may interfere with proper and coordinated function of respiratory muscles followed by hypoxia and respiratory acidosis. Increased plasma catecholamines can cause a decay of skeletal muscle cells and cardiac function, including stress cardiomyopathy. Systemic complications are often underestimated or misinterpreted as they may mimic underlying causes of generalized convulsive status epilepticus or treatment-related adverse events.

CONCLUSIONS

Management of generalized convulsive status epilepticus should center on the administration of antiseizure drugs, treatment of the underlying causes, and the attendant systemic consequences to prevent secondary seizure-related injuries. Heightened awareness, systematic clinical assessment, and diagnostic workup and management based on the proposed algorithm are advocated as they are keys to optimal outcome.

Progressive scoliosis in early, non-progressive CNS injuries: role of axial muscles

Forty-three patients with progressive neurological deficits involving axial musculature, starting 3-6 years after non-progressive brain injuries insults are described. Losses of function followed period of several years of stable motor deficits. Subsequent losses were stereotypic, with loss of ambulation and scoliosis, followed by loss of word articulation, malalignment of the mandible and ultimately neurogenic impairment of swallowing. Physical therapy, serial castings and spinal instrumentation palliated specific musculoskeletal problems but did not alter the relentless loss of various functions. The balanced action of paired axial muscles (i.e. spine, proximal muscle groups of the lower extremities, oropharynx, mastication) is regulated by the brainstem with modulation by the cerebral hemispheres. The clinical evolution in these patients suggest that, in the absence of normal input from the cerebral hemispheres, some patients have a progressive loss of these brainstem mechanisms. The most resistant functions (last ones to be lost), seem to be the ones phylogenetically most relevant for survival, such as suction and swallowing.