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Wang M, Yu J, Xiao X, Zhang B, Tang J. Changes of biochemical biomarkers in the serum of children with convulsion status epilepticus: a prospective study. BMC Neurol 2022; 22:196. [PMID: 35624413 PMCID: PMC9137178 DOI: 10.1186/s12883-022-02686-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 04/20/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Convulsive status epilepticus (CSE) is a common neurologic emergency with high morbidity and mortality. This single center study is aimed to assess changes of serum biochemical biomarkers after seizure, and their associations with the development of CSE. METHODS From January 2015 to October 2016, a total of 57 CSE patients, and 30 healthy controls without central nervous system diseases were enrolled in Children's Hospital of Soochow University. CSE patients were further divided into viral encephalitis (VEN, 13 cases), primary generalized epilepsy (PGE, 30 cases), and complex febrile seizures (CFS, 14 cases). The levels of serum biochemical biomarkers were measured using the corresponding commercial ELISA kits. Logistic regression analysis was performed to identify the associations between these biomarkers and diseases. RESULTS At the 1st and 4th day of CSE, neuron-specific enolase (NSE; 1st day: 20.553 ± 5.360, 4th day: 10.094 ± 3.426) and vascular endothelial growth factor (VEGF; 1st day: 153.504 ± 31.246, 4th day: 138.536 ± 25.221) in the CSE group were increased compared to the control (NSE: 6.138 ± 1.941; VEGF: 119.210 ± 31.681). Both the levels of S-100 calcium binding protein B (S-100B; 1st day: 0.738 ± 0.391) and C-reactive protein (CRP; 1st day: 11.128 ± 12.066) were elevated at 1st day of CSE (S-100B: 0.387 ± 0.040; CRP: 3.915 ± 2.064). For glial fibrillary acidic protein (GFAP), it was remarkably upregulated at 4th day of CSE (3.998 ± 1.211). NSE (P = 0.000), S-100B (P = 0.000), CRP (P = 0.011), and VEGF (P = 0.000) at 1st day of CSE, and NSE (P = 0.000), VEGF (P = 0.005), and GFAP (P = 0.000) at 4th day of CSE were significantly associated with the occurrence of CSE. Besides, NSE (P = 0.002), S-100B (P = 0.001), and VEGF (P = 0.002) at 4th day of CSE were significantly associated with VEN. CONCLUSIONS The levels of serum NSE, S-100B, CRP, VEGF, and GFAP are associated with CSE.
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Affiliation(s)
- Manli Wang
- Department of Neurology, Children's Hospital of Soochow University, No.92, Zhongnanjie Road, Suzhou, 215025, Jiangsu, China
| | - Jian Yu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215025, Jiangsu, China
| | - Xiao Xiao
- Department of Neurology, Children's Hospital of Soochow University, No.92, Zhongnanjie Road, Suzhou, 215025, Jiangsu, China
| | - Bingbing Zhang
- Department of Neurology, Children's Hospital of Soochow University, No.92, Zhongnanjie Road, Suzhou, 215025, Jiangsu, China
| | - Jihong Tang
- Department of Neurology, Children's Hospital of Soochow University, No.92, Zhongnanjie Road, Suzhou, 215025, Jiangsu, China.
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Felipe N, Alblaihed L, Dezman Z, Bontempo L. 58-year-old Male with a Headache, Hand Numbness, and Phantosmia. Clin Pract Cases Emerg Med 2022; 6:112-116. [PMID: 35701351 PMCID: PMC9197741 DOI: 10.5811/cpcem.2022.4.56508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: A 58-year-old male presents to the emergency department with headache, hand numbness, and phantosmia.
Case Presentation: Magnetic resonance imaging showed multiple acute and early subacute lesions involving the cortex and subcortical white matter of the left frontal lobe, left parietal lobe, left temporal lobe, left caudate, and left putamen.
Discussion: This case takes the reader through the subtle findings that led to the diagnosis and ultimately to treatment.
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Affiliation(s)
- Naillid Felipe
- University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland
| | - Leen Alblaihed
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Zachary Dezman
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland; University of Maryland, Department of Epidemiology and Public Health, Baltimore, Maryland
| | - Laura Bontempo
- University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
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Umashankar MS, Kumar AB. Clinical Case Presentation on Absence Seizures Diagnosis and Treatment Care Services and Outcomes in an Adult Patient. J Neurosci Rural Pract 2019; 10:154-157. [PMID: 30765995 PMCID: PMC6337990 DOI: 10.4103/jnrp.jnrp_191_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Absence seizures are often associated with impaired or loss of consciousness clinically proved to have an impact on motor and cognitive abnormalities of the nerve cells of the brain. Seizure admits several etiopathophysiological events leading to several neurofunctional changes in the reticulothalamocortical circuitry zones of the central nervous system. This paves the episodes of absence seizure events. A clinical case report of absence seizure in a 25 years age adult patient came to the hospital with impaired consciousness. The brain magnetic resonance imaging scanning of the patient detected a small focal flair hypertensive area in the right parasellar region close to cavernous sinus with mild flair hypersensitivity in the left cavernous sinuses, right maxillary, and ethmoid sinusitis. The electroencephalogram of the brain showed normal waves with electrode artifacts was observed. The patient was confirmed with absence seizures, and he was treated with oxcarbazepine 150 mg twice daily. The patient was recovered from seizure and discharged with medications. He was called for follow-up examination once in 3-month period.
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Affiliation(s)
- M S Umashankar
- Department of Pharmaceutics, SRM College of Pharmacy, SRM Institute of Science and Technology, Kanchipuram, Tamil Nadu, India
| | - A Bharath Kumar
- Department of Pharmacy Practice, SRM College of Pharmacy, SRM Institute of Science and Technology, Kanchipuram, Tamil Nadu, India
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Sanello A, Gausche-Hill M, Mulkerin W, Sporer KA, Brown JF, Koenig KL, Rudnick EM, Salvucci AA, Gilbert GH. Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care. West J Emerg Med 2018; 19:527-541. [PMID: 29760852 PMCID: PMC5942021 DOI: 10.5811/westjem.2018.1.36559] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/15/2017] [Accepted: 01/04/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California. Methods We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management. Results Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol. Conclusion Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.
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Affiliation(s)
- Ashley Sanello
- Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California.,David Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services (EMS) Agency, Santa Fe Springs, California.,Harbor UCLA, Department of Emergency Medicine, Torrance, California.,David Geffen School of Medicine, Department of Emergency Medicine, Los Angeles, California.,EMS Medical Directors Association of California
| | - William Mulkerin
- Stanford University, Department of Emergency Medicine, Stanford, California
| | - Karl A Sporer
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.,EMS Medical Directors Association of California
| | - John F Brown
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.,EMS Medical Directors Association of California
| | - Kristi L Koenig
- EMS Medical Directors Association of California.,County of San Diego, Health & Human Services Agency, Emergency Medical Services, San Diego, California.,University of California, Irvine, Department of Emergency Medicine, Orange, California
| | - Eric M Rudnick
- EMS Medical Directors Association of California.,NorCal EMS Agency, Redding, California
| | - Angelo A Salvucci
- EMS Medical Directors Association of California.,Ventura County EMS Agency, Oxnard, California
| | - Gregory H Gilbert
- EMS Medical Directors Association of California.,Stanford University, Department of Emergency Medicine, Stanford, California
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Blades Golubovic S, Rossmeisl JH. Status epilepticus in dogs and cats, part 1: etiopathogenesis, epidemiology, and diagnosis. J Vet Emerg Crit Care (San Antonio) 2017; 27:278-287. [PMID: 28445615 DOI: 10.1111/vec.12605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 09/28/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review current knowledge of the etiopathogenesis, diagnosis, and consequences of status epilepticus (SE) in veterinary patients. DATA SOURCES Human and veterinary literature, including clinical and laboratory research and reviews. ETIOPATHOGENESIS Status epilepticus is a common emergency in dogs and cats, and may be the first manifestation of a seizure disorder. It results from the failure of termination of an isolated seizure. Multiple factors are involved in SE, including initiation and maintenance of neuronal excitability, neuronal network synchronization, and brain microenvironmental contributions to ictogenesis. Underlying etiologies of epilepsy and SE in dogs and cats are generally classified as genetic (idiopathic), structural-metabolic, or unknown. DIAGNOSIS Diagnosis of convulsive SE is usually made based on historical information and the nature of the seizures. Patient specific variables, such as the history, age of seizure onset, and physical and interictal neurological examination findings can help hone the rule out list, and are used to guide selection and prioritization of diagnostic tests. Electroencephalographic monitoring is routinely used in people to diagnose SE and guide patient care decisions, but is infrequently performed in veterinary medicine. Nonconvulsive status epilepticus has been recognized in veterinary patients; routine electroencephalography would aid in the diagnosis of this phenomenon in dogs and cats. CLINICAL SEQUELAE Status epilepticus is a medical emergency that can result in life-threatening complications involving the brain and systemic organs. Status epilepticus often requires comprehensive diagnostic testing, treatment with multiple anticonvulsant agents, and intensive supportive care.
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Affiliation(s)
| | - John H Rossmeisl
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, 24060
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An Emergency Medicine-Focused Review of Seizure Mimics. J Emerg Med 2016; 52:645-653. [PMID: 28007363 DOI: 10.1016/j.jemermed.2016.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Seizures result in a change in motor, sensory, and behavioral symptoms caused by abnormal neurologic electrical activity. The symptoms share similar presentations of several other conditions, leading to difficulties in diagnosis and frequent improper management. OBJECTIVE This review evaluates adult patients with suspected seizure, signs and symptoms of seizure, mimics of seizure, and an approach to management of seizure mimics. DISCUSSION A seizure is caused by abnormal neurologic electrical activity resulting in altered motor, sensory, and behavioral symptoms. Other conditions may present similarly, causing a challenge in diagnosis. These conditions include syncope, psychogenic nonepileptic seizures, stroke or transient ischemic attack, sleep disorders, movement disorders, and migraines. Diagnosis of seizures in the emergency department (ED) is often clinical. Differentiation between seizures and other conditions can be difficult. Laboratories and imaging provide little benefit in definitive diagnosis in the emergency setting. For patients that have an apparent seizure, resuscitation and management is precedent while identifying any provoking factors and treatment of those factors. For adults recovering from suspected seizure, the combination of a focused history, physical examination, and additional studies can provide assistance in diagnosis. CONCLUSIONS Patients with an apparent seizure should be resuscitated with identification of provoking factors. Many conditions can mimic seizures. A focused history, physical examination, and additional studies will assist in differentiating seizures from mimics.
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7
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Goonawardena J, Marshman LA, Drummond KJ. Brain tumour-associated status epilepticus. J Clin Neurosci 2015; 22:29-34. [DOI: 10.1016/j.jocn.2014.03.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/27/2014] [Accepted: 03/29/2014] [Indexed: 01/27/2023]
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Samala RV, Parala-Metz A, Davis MP. Nonconvulsive status epilepticus in a palliative care unit: when delirium is a seizure. Am J Hosp Palliat Care 2013; 32:243-7. [PMID: 24249828 DOI: 10.1177/1049909113512719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The search for an underlying cause of altered mental status not uncommonly becomes more challenging in the hospice and palliative care setting. Due to multiple coexisting conditions that affect mental status and shifting goals of care, discerning that single cause in this venue can become frustrating and even nonbeneficial at times. We present a case of nonconvulsive status epilepticus (NCSE), which multiple reports have shown to be a rarely contemplated cause of impaired consciousness. A concise review of NCSE follows, with emphasis on conditions that present similarly, precipitating factors, diagnostic and therapeutic considerations, and prognostic implications. Nonconvulsive status epilepticus is a reversible cause of altered consciousness, particularly when recognized promptly. In a palliative care unit, treatment should ultimately be guided by the patient's goals of care.
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Affiliation(s)
- Renato V Samala
- Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
| | - Armida Parala-Metz
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mellar P Davis
- The Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA
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MORIOKA T, SAYAMA T, SHIMOGAWA T, MUKAE N, HAMAMURA T, ARAKAWA S, SAKATA A, SASAKI T. Electroencephalographic Evaluation of Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery-Middle Cerebral Artery Anastomosis. Neurol Med Chir (Tokyo) 2013; 53:388-95. [DOI: 10.2176/nmc.53.388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Shuji ARAKAWA
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital
| | - Ayumi SAKATA
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
| | - Tomio SASAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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Efficacy of safety signals in the epilepsy monitoring unit (EMU): should we worry? Epilepsy Behav 2012; 23:458-61. [PMID: 22381392 DOI: 10.1016/j.yebeh.2012.01.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 01/14/2012] [Accepted: 01/17/2012] [Indexed: 11/23/2022]
Abstract
There is little consensus regarding the critical safety measures to prevent harm in epilepsy monitoring units (EMUs). We sought to determine whether the safety signals (SS) triggered during EMU events differed by seizure type and the efficacy of SS in alerting responders. We screened 468 consecutive EMU admissions from January 2008 until April 2011 for definitive events to evaluate the first 50 events of complex partial seizures (CPS), generalized tonic-clonic seizures (GTC), and psychogenic non-epileptic seizures (PNES). Response to telemetry signal was slower than to push button (PB). When there was PB alarm, response time was slower in patients with PNES. A higher proportion of PNES were triggered by PB. A greater percentage of epileptic seizures were missed compared with PNES. Future studies investigating more effective techniques to capture every epileptic seizure are warranted as 24/7 monitoring by healthcare professionals is not feasible in many settings.
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MORIOKA T, SAYAMA T, MUKAE N, HAMAMURA T, YAMAMOTO K, KIDO T, SAKATA A, SASAKI T. Nonconvulsive Status Epilepticus During Perioperative Period of Cerebrovascular Surgery. Neurol Med Chir (Tokyo) 2011; 51:171-9. [DOI: 10.2176/nmc.51.171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Tomomi KIDO
- Department of Clinical Laboratory, Kyushu Rosai Hospital
| | - Ayumi SAKATA
- Department of Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
| | - Tomio SASAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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Time-critical neurological emergencies: the unfulfilled role for point-of-care testing. Int J Emerg Med 2010; 3:127-31. [PMID: 20606822 PMCID: PMC2885257 DOI: 10.1007/s12245-010-0177-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 03/05/2010] [Indexed: 01/20/2023] Open
Abstract
Background Neurological emergencies are common and frequently devastating. Every year, millions of Americans suffer an acute stroke, severe traumatic brain injury, subarachnoid hemorrhage, status epilepticus, or spinal cord injury severe enough to require medical intervention. Aims Full evaluation of the diseases in the acute setting often requires advanced diagnostics, and treatment frequently necessitates transfer to specialized centers. Delays in diagnosis and/or treatment may result in worsened outcomes; therefore, optimization of diagnostics is critical. Methods Point-of-care (POC) testing brings advanced diagnostics to the patient’s bedside in an effort to assist medical providers with real-time decisions based on real-time information. POC testing is usually associated with blood tests (blood glucose, troponin, etc.), but can involve imaging, medical devices, or adapting existing technologies for use outside of the hospital. Noticeably missing from the list of current point-of-care technologies are real-time bedside capabilities that address neurological emergencies. Results Unfortunately, the lack of these technologies may result in delayed identification of patients of these devastating conditions and contribute to less aggressive therapies than is seen with other disease processes. Development of time-dependent technologies appropriate for use with the neurologically ill patient are needed to improve therapies and outcomes. Conclusion POC-CENT is designed to support the development of novel ideas focused on improving diagnostic or prognostic capabilities for acute neurological emergencies. Eligible examples include biomarkers of traumatic brain injury, non-invasive measurements of intracranial pressure or cerebral vasospasm, and improved detection of pathological bacteria in suspected meningitis.
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HAMAMURA T, MORIOKA T, SAYAMA T, MUKAE N, ARAKAWA S, MAEDA H, SASAKI T. Cerebral Hyperperfusion Syndrome Associated With Non-convulsive Status Epilepticus Following Superficial Temporal Artery-Middle Cerebral Artery Anastomosis -Case Report-. Neurol Med Chir (Tokyo) 2010; 50:1099-104. [DOI: 10.2176/nmc.50.1099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Shuji ARAKAWA
- Department of Cerebrovascular Disease, Kyushu Rosai Hospital
| | | | - Tomio SASAKI
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University
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