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Cao Y, Li H, Chen M, Wang P, Shi F, Zhu X, Peng A, Li S, Chen L. Evaluation and systematic review of guidance documents for status epilepticus. Epilepsy Behav 2024; 150:109555. [PMID: 38128315 DOI: 10.1016/j.yebeh.2023.109555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023]
Abstract
Guidance documents play a pivotal role in shaping the management of status epilepticus (SE). However, the methodological quality of these documents remains uncertain. In this systematic review, we comprehensively searched 12 literature and guideline databases to assess the quality of clinical practice guidelines and consensus statements related to SE management using the AGREE II methodology. Additionally, we summarized the associated recommendations. We identified a total of 14 clinical practice guidelines and 11 consensus statements spanning the period from 1993 to 2022. The median score for clarity of presentation was 71.8% (ranging from 15.3% to 91.7%), indicating generally good clarity. However, the aspect of editorial independence received poor ratings, with a median score of 32.1% (ranging from 0% to 83.3%). Notably, the 2016 guideline published by the American Epilepsy Society in Epilepsy (AES) received the highest overall scores. Across these guidance documents, there was consistency in the definition and diagnosis of SE. However, significant variability was observed in therapeutic recommendations, particularly in terms of the timing for adding or changing medications. The methodological approaches used in most SE guidance documents require improvement, and the disparities in recommendations highlight existing gaps in evidence. Enhanced methodological rigor results in increased standardization of the guideline, consequently augmenting its reference value. Given the urgency of SE as an emergency condition, it is imperative that these documents also address relevant management strategies before admission.
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Affiliation(s)
- Yue Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hua Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mingyue Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Pei Wang
- Department of Neurology, The First People's Hospital of Xianyang, China
| | - Fanfan Shi
- Department of Clinical Research and Management, Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Xi Zhu
- Department of Neurology, The Affiliated Hospital of Southwest Jiaotong University and The Third People's Hospital of Chengdu, China
| | - Anjiao Peng
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Sheyu Li
- Department of Endocrinology and Metabolism and Department of Guideline and Rapid Recommendation, Cochrane China Center, MAGIC China Center, Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Lei Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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McKenzie KC, Hahn CD, Friedman JN. Emergency management of the paediatric patient with convulsive status epilepticus. Paediatr Child Health 2021; 26:50-66. [PMID: 33552322 DOI: 10.1093/pch/pxaa127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 06/08/2020] [Indexed: 12/20/2022] Open
Abstract
This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than 1 month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.
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Affiliation(s)
- Kyle C McKenzie
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario
| | - Cecil D Hahn
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario
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McKenzie KC, Hahn CD, Friedman JN. La prise en charge d’urgence du patient pédiatrique en état de mal épileptique convulsif. Paediatr Child Health 2021. [DOI: 10.1093/pch/pxaa128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Résumé
Les présentes lignes directrices portent sur la prise en charge d’urgence de l’état de mal épileptique convulsif chez les nourrissons âgés de plus d’un mois et les enfants. Elles remplacent un document de principes publié en 2011 et comprennent un nouvel algorithme thérapeutique, de même qu’un tableau des médicaments recommandés en fonction de nouvelles données probantes qui reflètent l’évolution de la pratique clinique des quelques dernières années. Le présent document de principes souligne l’importance d’un traitement pharmacologique rapide de l’état de mal épileptique convulsif et contient des conseils relativement à la démarche diagnostique et aux soins de soutien.
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Affiliation(s)
- Kyle C McKenzie
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)
| | - Cecil D Hahn
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)
| | - Jeremy N Friedman
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)
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Leng X, Yuan F, Zhao J, Song C, Zhao Z, Zhang Y, Gao Q, Yang F, Jiang W. Long-term seizure outcome in patients with status epilepticus due to acute encephalitis. Seizure 2019; 69:70-75. [DOI: 10.1016/j.seizure.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 11/15/2022] Open
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Yuan F, Yang F, Jia R, Li W, Jiang Y, Zhao J, Jiang W. Multimodal Predictions of Super-Refractory Status Epilepticus and Outcome in Status Epilepticus Due to Acute Encephalitis. Front Neurol 2018; 9:832. [PMID: 30349506 PMCID: PMC6186801 DOI: 10.3389/fneur.2018.00832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/18/2018] [Indexed: 01/01/2023] Open
Abstract
Objective: Status epilepticus (SE) is one of the most critical symptoms of encephalitis. Studies on early predictions of progression to super-refractory status epilepticus (SRSE) and poor outcome in SE due to acute encephalitis are scarce. We aimed to investigate the values of neuroimaging and continuous electroencephalogram (EEG) in the multimodal prediction. Methods: Consecutive patients with convulsive SE due to acute encephalitis were included in this study. Demographics, clinical features, neuro-imaging characteristics, medical interventions, and anti-epileptic treatment responses were collected. All the patients had EEG monitoring for at least 24 h. We determined the early predictors of SRSE and prognostic factors of 3-month outcome using multivariate logistic regression analyses. Results: From March 2008 to February 2018, 570 patients with acute encephalitis were admitted to neurological intensive care unit (N-ICU) of Xijing hospital. Among them, a total of 94 patients with SE were included in this study. The percentage of non-SRSE and SRSE were 76.6 and 23.4%. Cortical or hippocampal abnormality on neuroimaging (p = 0.002, OR 20.55, 95% CI 3.16-133.46) and END-IT score (p < 0.001, OR 4.07, 95% CI 1.91-8.67) were independent predictors of the progression to SRSE. At 3 months after N-ICU discharge, 56 (59.6%) patients attained good outcomes, and 38 (40.4%) patients had poor outcomes. The recurrence of clinical or EEG seizures within 2 h after the infusion rate of a single anesthetic drug >50% proposed maximal dose (p = 0.044, OR 4.52, 95% CI 1.04-19.68), tracheal intubation (p = 0.011, OR 4.99, 95% CI 1.37-11.69) and emergency resuscitation (p = 0.040, OR 9.80, 95% 1.11-86.47) predicted poor functional outcome. Interpretation: Initial neuro-imaging findings assist early identification of the progression to SRSE. Continuous EEG monitoring contributes to outcome prediction in SE due to acute encephalitis.
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Affiliation(s)
- Fang Yuan
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ruihua Jia
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yongli Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jingjing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Nonconvulsive status epilepticus after convulsive status epilepticus: Clinical features, outcomes, and prognostic factors. Epilepsy Res 2018; 142:53-57. [PMID: 29555354 DOI: 10.1016/j.eplepsyres.2018.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/06/2018] [Accepted: 03/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate clinical characteristics and outcomes of nonconvulsive status epilepticus (NCSE) after convulsive status epilepticus (CSE) and determine risk factors for unfavorable outcomes. METHODS We reviewed consecutive patients with NCSE after CSE over eight years in the neurological intensive care unit. Clinical presentations and the Salzburg EEG criteria for NCSE were used to identify patients with NCSE after CSE. Demographics, clinical features, and anti-epileptic treatment responses were collected and analyzed. Modified Rankin Scale (mRS) was used to evaluate three-month outcomes. A multivariate logistic regression model was used to determine independent prognostic factors. RESULTS Among 145 consecutive patients with convulsive SE, 48 (33.1%) patents eventually evolved into NCSE. Two patients with cerebral anoxia were exclude. At three-month follow-up, 23 patients (50.0%) had mRS ≥ 3, and 16 (34.8%) died. Thirty-two patients (69.6%) were given continuous intravenous anesthetic drugs (CIVADs). Fourteen patients (30.4%) had CIVAD at the rate >50% proposed maximal dose (PMD). There was a single predictor factor found significant after multivariate logistic regression analysis: the recurrence of EEG seizures within two hours of initiation of CIVAD at a dose of greater than half the proposed maximal dose (OR, 9.63; 95%CI, 1.08-86.18; p = 0.043). The use of CIVAD, even with a high dose (>50% PMD), was not independently associated with unfavorable outcomes. CONCLUSIONS The recurrence of EEG seizures within two hours of initiation of CIVAD at a dose of greater than half the proposed maximal dose predicts unfavorable outcomes in NCSE after CSE. The refractoriness of the seizures might be a significantly greater risk for poor outcome in NCSE after CSE than treatment with CIVADs.
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25 years of advances in the definition, classification and treatment of status epilepticus. Seizure 2016; 44:65-73. [PMID: 27890484 DOI: 10.1016/j.seizure.2016.11.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Status epilepticus (SE) requires not only urgent symptomatic treatment with antiepileptic drugs but also rapid identification and treatment of its cause. This narrative review summarizes the most important advances in classification and treatment of SE. METHOD Data sources included MEDLINE, EMBASE, ClinicalTrials.gov, and back tracking of references in pertinent studies, reviews, and books. RESULTS SE is now defined as "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." A new diagnostic classification system of SE introduces four axes: semiology, aetiology, EEG correlates, and age. For the acute treatment intravenous benzodiazepines (lorazepam, diazepam, clonazepam) and intramuscular midazolam appear as most effective treatments for early SE. In children, buccal or intranasal midazolam are useful alternatives. In established SE intravenous antiepileptic drugs (phenytoin, valproate, levetiracetam, phenobarbital, and lacosamide) are in use. Treatment options in refractory SE are intravenous anaesthetics; ketamine, magnesium, steroids and other drugs have been used in super-refractory SE with variable outcomes. CONCLUSION Over the past 25 years major advances in definition, classification and understanding of its mechanisms have been achieved. Despite this up to 40% of patients in early status cannot be controlled with first line drugs. The treatment of super-refractory status is still an almost evidence free zone.
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Gao Q, Ou-Yang TP, Sun XL, Yang F, Wu C, Kang T, Kang XG, Jiang W. Prediction of functional outcome in patients with convulsive status epilepticus: the END-IT score. Crit Care 2016; 20:46. [PMID: 26916702 PMCID: PMC4768332 DOI: 10.1186/s13054-016-1221-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/06/2016] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Prediction of the functional outcome for patients with convulsive status epilepticus (CSE) has been a challenge. The aim of this study was to characterize the prognostic factors and functional outcomes of patients after CSE in order to develop a practicable scoring system for outcome prediction. METHODS We performed a retrospective explorative analysis on consecutive patients diagnosed with CSE between March, 2008 and November, 2014 in a tertiary academic medical center in northwest China. The modified Rankin Scale (mRS) was used to measure the functional outcome at three months post discharge. RESULTS A total of 132 CSE patients was included, with a median age of 25.5 years and 60.6% were male. Three months post discharge, an unfavorable outcome with mRS of 3-6 was seen in 62 (47.0%) patients, 25 (18.9%) of whom died. Logistic regression analysis revealed that encephalitis (p = 0.029), nonconvulsive SE (p = 0.018), diazepam resistance (p = 0.005), image abnormalities (unilateral lesions, p = 0.027; bilateral lesions or diffuse cerebral edema, p < 0.001) and tracheal intubation (p = 0.032) were significant independent predictors for unfavorable outcomes. Based on the coefficients in the model, these predictors were assigned a value of 1 point each, with the exception of the image, creating a 6-point scoring system, which we refer to as END-IT, for the outcome prediction of CSE. The area under the receiver operating characteristic curve for the END-IT score was 0.833 and using a cut-off point of 3 produced the highest sum sensitivity (83.9%) and specificity (68.6%). Compared with status epilepticus severity score (STESS) and Epidemiology-based Mortality score in SE (EMSE), END-IT score showed better discriminative power and predictive accuracy for the outcome prediction. CONCLUSIONS We developed an END-IT score with a strong discriminative power for predicting the functional outcome of CSE patients. External prospective validation in different cohorts is needed for END-IT score.
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Affiliation(s)
- Qiong Gao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Tang-peng Ou-Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Xiao-long Sun
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Feng Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Chen Wu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Tao Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Xiao-gang Kang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, PR China.
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Abstract
Intravenous and intramuscular antiseizure drugs (ASDs) are essential in the treatment of clinical seizure emergencies as well as in replacement therapy when oral administration is not possible. The parenteral formulations provide rapid delivery and complete (intravenous) or nearly complete (intramuscular) bioavailability. Controlled administration of the ASD is feasible with intravenous but not intramuscular formulations. This article reviews the literature and discusses the chemistry, pharmacology, pharmacokinetics, and clinical use of currently available intravenous and intramuscular ASD formulations as well as the development of new formulations and agents. Intravenous or intramuscular formulations of lorazepam, diazepam, midazolam, and clonazepam are typically used as the initial treatment agents in seizure emergencies. Recent studies also support the use of intramuscular midazolam as easier than the intravenous delivery of lorazepam in the pre-hospital setting. However, benzodiazepines may be associated with hypotension and respiratory depression. Although loading with intravenous phenytoin was an early approach to treatment, it is associated with cardiac arrhythmias, hypotension, and tissue injury at the injection site. This has made it less favored than fosphenytoin, a water-soluble, phosphorylated phenytoin molecule. Other drugs being used for acute seizure emergencies are intravenous formulations of valproic acid, levetiracetam, and lacosamide. However, the comparative effectiveness of these for status epilepticus (SE) has not been evaluated adequately. Consequently, guidelines for the medical management of SE continue to recommend lorazepam followed by fosphenytoin, or phenytoin if fosphenytoin is not available. Intravenous solutions for carbamazepine, lamotrigine, and topiramate have been developed but remain investigational. The current ASDs were not developed for use in emergency situations, but were adapted from ASDs approved for chronic oral use. New approaches for bringing drugs from experimental models to treatment of human SE are needed.
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Patterson EE, Leppik IE, Coles LD, Podell M, Vite CH, Bush W, Cloyd JC. Canine status epilepticus treated with fosphenytoin: A proof of principle study. Epilepsia 2015; 56:882-7. [PMID: 25953073 DOI: 10.1111/epi.12994] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There are a limited number of marketed intravenous antiepileptic drugs (AEDs) available to treat status epilepticus (SE). All were first developed for chronic therapy of epilepsy, not specifically for SE. Epilepsy and canine SE (CSE) occur naturally in dogs, with prevalence, presentation, and percentage of refractory cases similar to human epilepsy. The objective of this study was to determine if CSE treated with fosphenytoin (FOS) results in a similar responder rate as for people. METHODS A randomized clinical trial was performed for dogs with CSE. Dogs who presented during a seizure or who had additional seizures after enrolling received intravenous (i.v.) benzodiazepine (BZD) followed immediately by intravenous infusion of 15 mg/kg phenytoin equivalent (PE) of fosphenytoin (FOS) or saline placebo (PBO). If seizures continued, additional AEDs were administered per the standard of care for veterinary patients. Total and unbound plasma phenytoin (PHT) concentrations were measured. RESULTS Consent was obtained for 50 dogs with CSE. Thirty-one had additional motor seizures and were randomized to the study intervention (22 FOS and 9 PBO). There was a statistically significant difference in the 12 h responder rate, with 63% in the FOS group versus 22% in the placebo group (p = 0.043) having no further seizures. The unbound PHT concentrations at 30 and 60 min were within the therapeutic concentrations for people (1-2 μg/ml) with the exception of one dog. There was mild vomiting in 36% of the FOS group (7/22) within 20 min of FOS administration and none of the placebo group (0/9) (p = 0.064). SIGNIFICANCE This proof of concept study provides the first evidence that FOS is tolerated and effective in canine SE at PHT concentrations clinically relevant for human SE. Furthermore, naturally occurring CSE can be utilized as a translational platform for future studies of novel SE compounds.
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Affiliation(s)
- Edward E Patterson
- Veterinary Medical Center, University of Minnesota, St. Paul, Minnesota, U.S.A
| | - Ilo E Leppik
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A.,UMP MINCEP Epilepsy Care, Minneapolis, Minnesota, U.S.A
| | - Lisa D Coles
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Michael Podell
- Chicago Veterinary Neurology and Neurosurgery, Chicago, Illinois, U.S.A
| | - Charles H Vite
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - William Bush
- Bush Veterinary Neurology Service, Leesburg, Virginia, U.S.A
| | - James C Cloyd
- Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, Minnesota, U.S.A
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Redecker J, Wittstock M, Benecke R, Rösche J. Efficacy of perampanel in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Epilepsy Behav 2015; 45:176-9. [PMID: 25819947 DOI: 10.1016/j.yebeh.2015.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 12/24/2022]
Abstract
We provide some evidence concerning the efficacy of perampanel (PER) in refractory status epilepticus (SE). We retroactively identified patients with SE treated in our department by searching for the term "status epilepticus" in the electronic archive of medical records. We present and analyze in this paper the subset of data of the patients treated with PER. We analyzed ten episodes of SE in nine patients. At the first administration, PER was given in a dosage of 6mg to most of our patients (7 of 10). On average, PER was administered as the 6th antiepileptic drug (AED) (range: 2-10). Depending on the criterion for efficacy, PER appears effective for the termination of SE in 2 to 6 (of 10) episodes. Unfortunately, safety data for the administration of PER with loading doses needed for the treatment of SE are lacking. Because of this, PER should be used very carefully in refractory SE and only after first-line treatment options have failed.
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Affiliation(s)
- Juliane Redecker
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Matthias Wittstock
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Reiner Benecke
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
| | - Johannes Rösche
- Klinik und Poliklinik für Neurologie, Universität Rostock, Gehlsheimer Str. 20, 18147 Rostock, Germany.
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Plech T, Kaproń B, Luszczki JJ, Paneth A, Siwek A, Kołaczkowski M, Żołnierek M, Nowak G. Studies on the anticonvulsant activity of 4-alkyl-1,2,4-triazole-3-thiones and their effect on GABAergic system. Eur J Med Chem 2014; 86:690-9. [PMID: 25226229 DOI: 10.1016/j.ejmech.2014.09.034] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 09/08/2014] [Accepted: 09/10/2014] [Indexed: 11/29/2022]
Abstract
A series of 4-alkyl-5-(3-chlorobenzyl/2,3-dichlorophenyl)-2,4-dihydro-3H-1,2,4-triazole-3-thiones (1a-14a) were designed, synthesized and screened for their anticonvulsant properties. Moreover, the acute adverse-effect profile of the active compounds (1a-7a, 12a) with respect to impairment of motor performance was evaluated in the chimney test. Among 4-alkyl-5-(3-chlorobenzyl)-2,4-dihydro-3H-1,2,4-triazole-3-thiones, ethyl, butyl, pentyl, hexyl, and heptyl derivatives administered intraperitoneally in a dose of 300 mg/kg protected 100% of the tested animals at four pretreatment times (i.e., 15, 30, 60, 120 min). Taking into account the median effective and toxic doses as well as the time-course profile of anticonvulsant activity, 5-(3-chlorobenzyl)-4-hexyl-2,4-dihydro-3H-1,2,4-triazole-3-thione (4a) was proposed as the best tolerated and the most promising potential drug candidate. Finally, a radioligand binding assay was used to check whether the anticonvulsant activity of 4-alkyl-1,2,4-triazole-3-thiones was a result of their interactions (direct or allosteric) with GABAA receptor complex and/or their affinity to benzodiazepine (BDZ) binding sites.
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Affiliation(s)
- Tomasz Plech
- Department of Organic Chemistry, Medical University of Lublin, Chodzki 4a, 20-093 Lublin, Poland.
| | - Barbara Kaproń
- Department of Organic Chemistry, Medical University of Lublin, Chodzki 4a, 20-093 Lublin, Poland
| | - Jarogniew J Luszczki
- Department of Pathophysiology, Medical University of Lublin, Jaczewskiego 8, 20-090 Lublin, Poland; Isobolographic Analysis Laboratory, Institute of Rural Health, Jaczewskiego 2, 20-950 Lublin, Poland
| | - Agata Paneth
- Department of Organic Chemistry, Medical University of Lublin, Chodzki 4a, 20-093 Lublin, Poland
| | - Agata Siwek
- Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Marcin Kołaczkowski
- Department of Pharmaceutical Chemistry, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Maria Żołnierek
- Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
| | - Gabriel Nowak
- Department of Pharmacobiology, Jagiellonian University Medical College, Medyczna 9, 30-688 Kraków, Poland
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Kaputu-Kalala-Malu C, Birindabagabo JD, Walker TD, Mafuta-Musalu E, Ntumba-Tshitenge O, Preux PM, Misson JP. Evaluation of adherence to a convulsion management protocol for children in Rwanda. J Trop Pediatr 2014; 60:124-8. [PMID: 24336648 DOI: 10.1093/tropej/fmt094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Inappropriate seizure management may result in high morbidity and mortality. We assessed the adherence of health professionals in southern Rwanda to a national protocol for pharmacological management of seizures in children. A questionnaire featuring a 5-year-old child with generalized prolonged seizures was administered. The questions focused on the choice of initial treatment and the sequence of management following failure of the initial treatment choice. Benzodiazepine was chosen as initial therapy by 93.7% of physicians and 90.9% of nurses. Only 49.2% of physicians and 41% of nurses would repeat the initial treatment in case of failure of the first dose and 47% of doctors would wait 30 min to intervene. In case of refractory status epilepticus, 34% of physicians would give three doses of benzodiazepine, whereas 19% did not know what to do. These results suggest poor adherence to national protocol.
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Affiliation(s)
- Célestin Kaputu-Kalala-Malu
- Child Neurology Service, Centre Neuropsychopathologique /CNPP, Kinshasa University Teaching Hospital, Kinshasa School of Medicine, University of Kinshasa, Po Box 825- Kinshasa, Republic Democratic of Congo
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Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Treatment and course of different subtypes of status epilepticus. Epilepsy Res 2013; 107:156-62. [DOI: 10.1016/j.eplepsyres.2013.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/25/2013] [Accepted: 08/03/2013] [Indexed: 11/29/2022]
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Dorandeu F, Dhote F, Barbier L, Baccus B, Testylier G. Treatment of status epilepticus with ketamine, are we there yet? CNS Neurosci Ther 2013; 19:411-27. [PMID: 23601960 PMCID: PMC6493567 DOI: 10.1111/cns.12096] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 02/23/2013] [Accepted: 02/23/2013] [Indexed: 12/24/2022] Open
Abstract
Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.
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Affiliation(s)
- Frederic Dorandeu
- Département de Toxicologie et risques chimiques, Institut de Recherche Biomédicale des Armées - Centre de Recherches du Service de Santé des Armées (IRBA-CRSSA), La Tronche Cedex, France.
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Dorandeu F, Barbier L, Dhote F, Testylier G, Carpentier P. Ketamine combinations for the field treatment of soman-induced self-sustaining status epilepticus. Review of current data and perspectives. Chem Biol Interact 2013; 203:154-9. [DOI: 10.1016/j.cbi.2012.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 09/25/2012] [Accepted: 09/26/2012] [Indexed: 12/21/2022]
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The administration of rescue medication to children with prolonged acute convulsive seizures in the community: what happens in practice? Eur J Paediatr Neurol 2013; 17:14-23. [PMID: 22863944 DOI: 10.1016/j.ejpn.2012.07.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Accepted: 07/15/2012] [Indexed: 11/24/2022]
Abstract
This paper presents the findings of a review of existing clinical and non-clinical guidance on the management of children with prolonged acute convulsive seizures (PCS) and the administration of rescue medication in community settings. Findings are based on desk- and web-based research in 6 countries. Published clinical guidelines are mostly limited to the hospital setting and offer few explicit recommendations for community settings. Non-clinical guidance on the management of medicines at school exists at the national or regional level in all 6 countries, however rescue epilepsy medication is often not mentioned specifically. Existing legal frameworks are vague and open to interpretation. As a result, whether a child receives rescue medication at school depends primarily on the availability of a willing teacher who accepts responsibility for administering it to that child during school hours. Comprehensive guidelines are clearly needed that provide practical guidance to ensure that children with PCS are treated as quickly as possible in all community settings. Recommendations for future action include: providing clearer information on PCS and rescue medication to parents and schools; putting in place an individual healthcare plan for every child with a history of PCS at his or her school; collecting more empirical data to gain a better understanding of the experience of children with PCS at school, their parents and teachers; and finally, implementing systematic training for all carers of children with PCS. The epilepsy specialist may play an important role in ensuring that these recommendations are put into place for their patients.
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Friedman J. Emergency management of the paediatric patient with generalized convulsive status epilepticus. Paediatr Child Health 2012; 16:91-104. [PMID: 22294869 DOI: 10.1093/pch/16.2.91] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The present guideline paper addresses the emergency management of generalized convulsive status epilepticus (CSE) in children and infants older than one month of age. It replaces the previous statement from 1996, and includes a new treatment algorithm and table of recommended medications, reflecting new evidence and the evolution of clinical practice over the past 15 years. The document focuses on the acute pharmacological management of CSE, but some issues regarding supportive care, diagnostic approach and treatment of refractory CSE are discussed.
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Affiliation(s)
- Felix Rosenow
- Department of Neurology, Philipps-University Marburg, Marburg, Germany.
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Leppik IE, Patterson EN, Coles LD, Craft EM, Cloyd JC. Canine status epilepticus: a translational platform for human therapeutic trials. Epilepsia 2011; 52 Suppl 8:31-4. [PMID: 21967357 DOI: 10.1111/j.1528-1167.2011.03231.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Current treatment of human status epilepticus (SE) relies on drugs developed for chronic treatment of epilepsy. Many potent compounds have been discovered in animal models of SE. But they may never be useful for chronic treatment of epilepsy and thus not available for human use. Naturally occurring canine SE may become a translational platform for evaluating these compounds for eventual use in human trials. A pilot study of levetiracetam in canine SE demonstrated a 56% response rate compared to 10% for placebo. Based on these results we have obtained an NIH R-21 to further evaluate canine SE as a translational platform for developing new approaches for treating human SE.
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Affiliation(s)
- Ilo E Leppik
- Department of Experimental & Clinical Pharmacology, College of Pharmacy, University of Minnesota, 717 Delaware St SE,Minneapolis, MN 55414, USA.
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21
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Oral ketamine controlled refractory nonconvulsive status epilepticus in an elderly patient. Seizure 2011; 20:723-6. [DOI: 10.1016/j.seizure.2011.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 04/24/2011] [Accepted: 06/07/2011] [Indexed: 11/17/2022] Open
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Roberts JI, Metcalfe A, Abdulla F, Wiebe S, Hanson A, Federico P, Jetté N. Neurologists' and neurology residents' knowledge of issues related to pregnancy for women with epilepsy. Epilepsy Behav 2011; 22:358-63. [PMID: 21852198 DOI: 10.1016/j.yebeh.2011.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 10/17/2022]
Abstract
We aimed to assess physician knowledge for 2009 guidelines established by the American Academy of Neurology and American Epilepsy Society regarding issues related to pregnancy for women with epilepsy. A questionnaire was developed and distributed to all neurologists and neurology residents practicing in a large Canadian health region serving a population of 1.4 million. Descriptive statistics were obtained and percentage of correct responses was calculated. Forty-five physicians completed the survey (response rate = 83.3%), with a median correct score of 50%. Residents were more likely (93.3%) to state that this information was important to their practice than staff physicians (40.0%). Overall knowledge of outcomes associated with specific AEDs was poor; less than half of the physicians correctly indicated which AEDs were associated with adverse outcomes for the majority of drug-related questions. We recommend multifaceted, interactive implementation strategies for increasing knowledge of guideline contents.
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Affiliation(s)
- Jodie I Roberts
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Rantsch K, Walter U, Wittstock M, Benecke R, Rösche J. Efficacy of intravenous lacosamide in refractory nonconvulsive status epilepticus and simple partial status epilepticus. Seizure 2011; 20:529-32. [DOI: 10.1016/j.seizure.2011.03.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 03/12/2011] [Accepted: 03/18/2011] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND Intracerebral hemorrhage (ICH) care can vary among centers and previous studies have demonstrated differences in ICH outcome based on variations in patient care in various settings. The purpose of this paper is to present the design of an evidence-based dataset of elements of a new ICH specific intensity of care quality metrics. METHODS The articles were identified based on personal knowledge of the subject supplemented by data derived from multi-center randomized trials, and selected non-randomized or observational clinical studies. The information was identified with multiple searches on MEDLINE from 1986 through 2009. The current guidelines from American Heart Association (AHA)/American Stroke Association (ASA) Stroke Council and The European Stroke Initiative (EUSI) Writing Committee for management of ICH were reviewed extensively for identifying quality indicators and available scientific evidence. For certain elements where stroke-specific data was not available, data derived from other disease process with direct relevance was used. RESULTS A total of 26 quality indicators related to 18 facets of care with thresholds for quality response were identified. A pilot study was performed to asses and score 1300 (26 indicator per patientX25 patientsX2 raters) quality indicators. The minimum proportion of patients meeting quality parameter ranged from 44% to 100% depending upon the variable. The lowest performance scores were observed in the early intubation and mechanical ventilation, treatment of significant intracranial mass effect or transtentorial herniation, and timely acquisition of neuroimaging. The highest performance scores were seen in treatment of any seizure within 2 weeks of admission, status epilepticus, and prevention of gastric ulcer. CONCLUSIONS The next step in development of a new ICH specific intensity of care quality metrics is validation and refinement of the quality indicators and thresholds presented in the current report. Future activities may include selection and validation based on consensus of experts and application of the system to a large series of patients with ICH and assessment of relationship of components in isolation and as a group to outcome after severity adjustment.
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Affiliation(s)
- Adnan I Qureshi
- Zeenat Qureshi Stroke Research Center, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
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Friedman JN. La prise en charge d’urgence due patient pédiatrique en état de mal épileptique convulsif généralisé. Paediatr Child Health 2011. [DOI: 10.1093/pch/16.2.98] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Koubeissi MZ, Mayor CL, Estephan B, Rashid S, Azar NJ. Efficacy and safety of intravenous lacosamide in refractory nonconvulsive status epilepticus. Acta Neurol Scand 2011; 123:142-6. [PMID: 21198444 DOI: 10.1111/j.1600-0404.2010.01430.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lacosamide (LCM) is a novel antiepileptic drug (AED) recently approved as an adjunctive therapy in the treatment of partial seizures in adults. LCM is available in oral and intravenous formulations, has linear pharmacokinetics and a unique mechanism of action. THE AIM OF THIS STUDY To evaluate the safety and efficacy of intravenous LCM in the treatment of nonconvulsive status epilepticus (NCSE) after failure of conventional therapy. METHODS We retrospectively reviewed all patients with NCSE treated with LCM. We reviewed the clinical and electrographic changes before and after LCM administration. We also noted any reported side effects including electrocardiographic changes. RESULTS We report four cases of NCSE that were refractory to conventional treatment, but readily responsive to LCM. No side effects attributable to LCM were identified. CONCLUSIONS Intravenous LCM may be safe and efficacious as an add-on AED for the treatment of NCSE when standard therapy fails.
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Affiliation(s)
- M Z Koubeissi
- Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106-5040, USA.
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Community views on neurologic emergency treatment trials. Ann Emerg Med 2010; 57:346-354.e6. [PMID: 20875693 DOI: 10.1016/j.annemergmed.2010.07.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE We improve our understanding of the community consultation process for acute neurologic emergency trials conducted under the federal regulations for Exception From Informed Consent (EFIC) for emergency research. METHODS We performed a qualitative study using focus groups to collect data from patients with a previous stroke or brain injury and their families and from young men at risk for traumatic brain injury. Discussions were transcribed, coded, and analyzed for major themes and subthemes. RESULTS Five focus groups, involving 40 participants, were convened. Major themes included the awareness and understanding of key clinical trial concepts, including prominent concerns about placebo and therapeutic misconception; inability to obtain informed consent and acceptable surrogate decision-making; EFIC in emergency research and whether existing regulations are acceptable; specific trial design problems, including comparison to standard of care versus 2 competing active therapies; and community consultation and representation. CONCLUSION In this study sample, EFIC trials were deemed appropriate and acceptable for acute neurologic emergency research. Education, along with open discussion about basic clinical research concepts, disease- and trial-specific information, and potential surrogate decision-making, was essential to determine the acceptability of an EFIC trial. Approval by institutional review boards was highly regarded as a means of human protection and effective community consultation for such trials. A data repository of information gained from similar qualitative research may help investigators and regulators who wish to plan, conduct, review, and provide oversight for acute neurologic emergency trials under EFIC regulations.
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Tilz C, Resch R, Hofer T, Eggers C. Successful treatment for refractory convulsive status epilepticus by non-parenteral lacosamide. Epilepsia 2010; 51:316-7. [DOI: 10.1111/j.1528-1167.2009.02256.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Leppik IE, Patterson E, Hardy B, Cloyd JC. Canine status epilepticus: Proof of principle studies. Epilepsia 2009; 50 Suppl 12:14-5. [PMID: 19941512 DOI: 10.1111/j.1528-1167.2009.02362.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kasner SE, Del Giudice A, Rosenberg S, Sheen M, Luciano JM, Cucchiara BL, Messé SR, Sansing LH, Baren JM. Who will participate in acute stroke trials? Neurology 2009; 72:1682-8. [PMID: 19433742 DOI: 10.1212/wnl.0b013e3181a55fbe] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the high incidence of acute stroke, only a minority of patients are enrolled in acute stroke treatment trials. We aimed to identify factors associated with participation in clinical trials of novel therapeutic agents for acute stroke. METHODS Prospective survey of patients with acute stroke <72 hours from onset. A structured interview was administered to the patient or primary decision-maker. If offered participation in an actual acute treatment trial, questions focused on decisions about that trial; otherwise a similar mock trial was proposed. The primary outcome was whether the subject agreed to participate in the proposed trial. RESULTS A total of 200 subjects (47% patients, 53% proxies) completed the survey: mean age 63 +/- 14 years, 47% women, 44% white, 50% black. A real acute trial was offered to 22%; others were offered a mock trial. Overall, 57% (95% confidence interval: 50%-64%) of respondents stated they would participate in the proposed acute treatment trial. There were no differences with respect to age, sex, race, educational level, self-assessed stroke severity or stroke type, vascular risk factors, or comorbidities. Misconceptions about key research concepts were found in 50% but did not impact participation. Participation was associated with the perceived risk of the proposed trial intervention (p < 0.001), prior general attitudes about research (p < 0.001), and influences attributed to family, religion, and other personal beliefs (p < 0.001). Patients were more likely to participate than proxy decision-makers (p = 0.04). CONCLUSIONS Demographic factors, clinical factors, and prior knowledge about research have little impact on the decision to participate in acute stroke clinical trials. Preexisting negative attitudes and external influences about research strongly inhibit participation. Patients are more inclined to participate than their proxy decision-makers.
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Affiliation(s)
- S E Kasner
- Department of Neurology, University of Pennsylvania Medical Center, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Knake S, Hamer HM, Rosenow F. Status epilepticus: a critical review. Epilepsy Behav 2009; 15:10-4. [PMID: 19236943 DOI: 10.1016/j.yebeh.2009.02.027] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
Abstract
Status epilepticus (SE) is a major neurological emergency with an incidence of about 20/100,000 and a mortality between 3 and 40% depending on etiology, age, status type, and status duration. Generalized tonic-clonic SE, in particular, requires immediate, aggressive, and effective treatment to stop seizure activity, and to prevent neuronal damage and systemic complications and death. Benzodiazepines and phenytoin/fosphenytoin are traditionally used as first-line drugs and are effective in about 60% of all episodes. However, a notable portion of patients remain in SE. For those, narcotics and induction of general anesthesia are used as second-line treatment. Therefore, there is a need for more effective first-line treatment options. Recently, valproic acid was approved for the treatment of status epilepticus in some European countries, and two of the newer antiepileptic drugs have become available for intravenous use: Levetiracetam (LEV) and lacosamide (LCM) should be evaluated in prospective controlled trials as possible treatment options. Standardized protocols for the management of SE are useful to improve immediate care.
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Affiliation(s)
- Susanne Knake
- Interdisciplinary Epilepsy Center Marburg, Department of Neurology, Philipps University Marburg, Rudolf-Bultmann-Strasse 8, 35033 Marburg, Germany.
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Outin H. [Emergency and intensive care unit management of status epilepticus Société de réanimation de langue française Experts Recommendations: the transient triumph of the followers of Sisyphus?]. Rev Neurol (Paris) 2009; 165:293-5. [PMID: 19296999 DOI: 10.1016/j.neurol.2009.01.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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