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Vafaee-Shahi M, Soltanieh E, Saidi H, Riahi A. Etiology, Risk Factors, Mortality and Morbidity of Status Epilepticus in Children: A Retrospective Cross-Sectional Study in Tehran, Iran. Open Neurol J 2020. [DOI: 10.2174/1874205x02014010095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Risk factors identification associated with status epilepticus is valuable in order to prevent morbidity and mortality in children. This study aimed to consider the etiology, risk factors, morbidity and mortality in children with status epilepticus.Methods:This retrospective cross-sectional study was performed on 119 patients aged from one month old to 15 years old. Patients’ data were recorded, including basic demographic, etiology and clinical information. The different risk factors correlated to morbidity and mortality were evaluated in this study.Results:The most common etiologies were acute symptomatic and febrile status epilepticus by 32.8% and 22.7%, respectively. Abnormal brain imaging results were reported far more frequently in patients with a history of neurodevelopmental delay and previous status epilepticus (p<0.001). The overall morbidity and mortality rates were 18.9% and 10.9%, respectively; while these rates in patients with delayed development (45.16% and 18.42%, respectively) were significantly higher than patients with normal development (8% and 7.4%, respectively). The morbidity rates in patients with previous seizures and previous status epilepticus were remarkably higher than those without previous history of seizure (26.41% vs 11.32%; p=0.047) and without previous status epilepticus (36.36%versus14.28%; p=0.018). The length of hospital stay in patients with mortality was considerably longer than patients without mortality (12.30 ± 16.1 days vs 7.29 ± 6.24 days; p=0.033). The mortality rate in patients with normal Lumbar Puncture result was notably lower than those with abnormal LP result (2.9% vs 50%). The morbidity rate in patients with abnormal brain imaging results (p<0.001) was significantly greater than those in patients with normal results. The mortality rate was relatively higher in patients with abnormal imaging results compared to those normal results. Etiology was an important predictor of mortality and morbidity rates; acute symptomatic (32.8%), febrile status epilepticus (22.7%) and remote symptomatic (16.8%) etiologies were the most common underlying causes of S.E. While in children less than 3 years old, the acute symptomatic etiology and febrile status epilepticus etiologies were estimated as the most common, in most patients older than 3 years old the most common etiology of status epilepticus was unknown. Congenital brain defects etiology had the highest mortality (36.36%) and morbidity (42.85%) rate. The lowest morbidity (3.84%) and mortality (0%) rates were for patients with febrile status epilepticus etiology.Conclusion:Age, developmental delay, history of previous status epilepticus, the length of hospital stay, abnormal brain imaging results and the underlying etiology of status epilepticus were associated with increased morbidity and mortality among children with status epilepticus.
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Wang CH, Zhu N. Protective role of sitagliptin against oxidative stress in a kainic acid-induced status epilepticus in rats models via Nrf2/HO-1 pathway. Drug Dev Res 2019; 80:446-452. [DOI: 10.1002/ddr.21516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 12/28/2018] [Accepted: 01/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Chong-Hao Wang
- Department of Neurology; Beijing Tiantan Hospital, Capital Medical University; Beijing China
| | - Na Zhu
- Biotech Center for Viral Disease Emergency; National Institute for Disease Control and Prevention, Chinese Disease Control and Prevention; Beijing China
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Lapmag A, Lertsinudom S, Chaiyakam A, Sawanyawisuth K, Tiamkao S. Clinical outcomes of intravenous levetiracetam treatment in patients with renal impairment. Neurol Int 2018; 10:7469. [PMID: 30344963 PMCID: PMC6176471 DOI: 10.4081/ni.2018.7469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 01/25/2018] [Accepted: 03/09/2018] [Indexed: 11/23/2022] Open
Abstract
Intravenous levetiracetam has been approved for use as an antiepileptic drug, as well as in cases of status epilepticus. There are few reports that detail the clinical data and outcomes associated with this antiepileptic drug, particularly in patients with renal impairment. This was a retrospective analytical study conducted at Khon Kaen University's Srinagarind Hospital in Thailand. The study period was between January 1, 2010 and December 31, 2014. The inclusion criteria were that patents were over 15 years old, had renal impairment, and had received intravenous levetiracetam treatment. The main clinical outcomes were seizure control and mortality. Clinical outcomes were compared between those with and without status epilepticus. Mortality of patients with status epilepticus were compared in terms of seizure control and order of intravenous levetiracetam treatment. During the study period, there were 247 patients who met the study criteria. The average age of the patients was 58 years with nearly equal sex distribution. Of those, 90 patients (36.4%) had GRFs of less than 15 mL/min/1.73 m2 and 60 patients (24.3%) received intravenous LEVE due to status epilepticus. The seizure control rates in the status epilepticus and non-status epilepticus groups were 36.7% and 88.7%, respectively (P<0.001). The mortality rate did not differ significantly between the two groups (33.3% vs 27.8%; P=0.418). There was no significant overall difference in mortality rate between seizure-controlled and seizure-uncontrolled patients in the status epilepticus group. In the convulsive status epilepticus group, variations in terms of treatment order of intravenous levetiracetam and seizure control resulted in no significant difference in mortality rates (P=0.311). No major side effects were detected in any patients after the intravenous levetiracetam treatment. In conclusion, intravenous levetiracetam treatment was effective and safe in patients with renal impairment.
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Affiliation(s)
- Anyamanee Lapmag
- Cinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University.,The College of Pharmacotherapy of Thailand, Pharmacy Council, Bangkok
| | - Sunee Lertsinudom
- Cinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University.,The College of Pharmacotherapy of Thailand, Pharmacy Council, Bangkok.,Integrated Epilepsy Research Group, Khon Kaen University
| | - Aporanee Chaiyakam
- Cinical Pharmacy Division, Faculty of Pharmaceutical Sciences, Khon Kaen University.,The College of Pharmacotherapy of Thailand, Pharmacy Council, Bangkok
| | | | - Somsak Tiamkao
- Integrated Epilepsy Research Group, Khon Kaen University.,Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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Willems LM, Kay L, Rosenow F, Strzelczyk A. Krankheitskosten und Outcome: Versorgungsrealität des Status epilepticus. ZEITSCHRIFT FUR EPILEPTOLOGIE 2018. [DOI: 10.1007/s10309-018-0205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hommady RH, Alrifai MT, Mubayrik OK, Alayed RS, Alsemari MA, Arumayyan A, Altuwaijri W, Baarmah D. Retrospective review of pediatric status epilepticus in 116 Saudi patients: predictors of outcome. Ann Saudi Med 2017; 37:455-460. [PMID: 29229894 PMCID: PMC6074125 DOI: 10.5144/0256-4947.2017.455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Status epilepticus (SE) is a common, life-threatening condition. Multiple factors are used to predict its outcome and evaluate its risks, and there have been only a few studies in Saudi Arabia. OBJECTIVES Investigate predictors of SE outcome. DESIGN Retrospective chart review study. SETTING Tertiary center, Riyadh. PATIENTS AND METHODS We reviewed all pediatric cases (age 14 years or younger) of SE admitted between January 2005 and December 2015, collecting data on age, sex, date of birth, developmental status, pre-existing neurological diseases, SE etiology, Glasgow Outcome Scale (GOS) scores, and electroencephalogram (EEG) findings. The outcome was categorized as poor based on any decrease in baseline GOS score or moderate-to-severe developmental delay in young children; otherwise outcome was considered good. MAIN OUTCOME MEASURE Outcome of SE. RESULTS One hundred and sixteen patients (54% boys) with ages from 1 month to 10 years were included in the analysis. Fifty-five (47.4%) had a poor outcome. The overall mortality rate related to SE was 2.6%. Four patients had an SE duration of more than 24 hours. Univariate and multivariate analysis revealed that poor outcome was related to symptomatic SE etiology and a history of epilepsy. Age, sex, SE duration, and EEG findings were not predictors of poor outcome. CONCLUSION Pediatric status epilepticus is highly associated with neurological morbidity. The main pre.dictor of outcome is underlying symptomatic etiology of SE and to a lesser degree the presence of a history of epilepsy. Duration does not seem to play a major role. LIMITATIONS The main limitation is the retrospective chart review nature of the study with possible bias.
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Affiliation(s)
| | - Muhammad Talal Alrifai
- Dr. Muhammad Talal Alrifai, Department of Pediatrics Neurology,, King Abdulaziz Medical City,, King Abdullah Specialized Children's Hospital,, Riyadh, Saudi Arabia, T: +966506404163, , ORCID ID: https://orcid.org/0000-0002-5203-438X
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Asadollahi A, Saberi LF, Havasi A, Kaveh MH. Psychometric Properties of the Persian Version of the Quality of Life in Epilepsy Inventory in the Later Life. J Epilepsy Res 2017; 6:59-65. [PMID: 28101476 PMCID: PMC5206101 DOI: 10.14581/jer.16012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 06/06/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND PURPOSE The reports indicate on the incidence of seizure disorder about 1.5 per cent of the normal elderly population. The Quality of Life in Epilepsy Inventory (QOLIE-31) has been pervasive simple tool to screen seizure in the busy neurophysiological settings and monitoring. It was constructed as self-administered tool in two formats, 89 and 31-items. To the reliability and validity of the QOLIE-31 across older adults in the southwest Iran and discuss its role in the detection of health-related quality of elderly patients with epilepsy. METHODS About 73 older adults (mean age = 66.3 ± 1.71) were sampled from the eight hospitals and caring centres. They replied to the QOLIE-31. External and criterion validity was calculated by correlation to the SF-36 questionnaire, to check and validate the epilepsy specific dimensions. The QOLIE-31 includes seven subscales: overall quality of life, seizure worry, emotional well-being, energy/fatigue, cognitive, medication effects, and social function. RESULTS There was significant difference within sample groups regarding main variables (p < 0.05). The coefficients of Cronbach's alpha (α= 0.76), convergent validity (0.81), divergent validity (-0.21), external validity with overall score of SF-36 (0.87), and criterion validity (0.78) were estimated, which were significant at p < 0.01. The exploratory factor analysis demonstrated that the QOLIE-31 is organized into six factors, which clarifies 92 per cent of the scale's variance. Second-order confirmatory factor analysis pointed out that the factor is well matched up onto a principal factor. Consequently, the 6-factors model was well appropriate for the data by the fit index techniques for adjusting the scale (AGFI = 0.94, GFI = 0.96, RMSEA = 0.003, IFI = 0.90, NFI = 0.95, CFI = 0.95). CONCLUSIONS The results pointed to the well-adjusted reliability and psychometric properties of the QOLIE-31 and its usefulness for the relevant studies as well.
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Affiliation(s)
- Abdolrahim Asadollahi
- Australian Centre for Quality of Life, Deakin University, Melbourne, Australia; Department of Healthy Aging, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Fani Saberi
- Department of Community Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Havasi
- Department of Social Work, University of Applied Science & Technology, Ahwaz, Iran
| | - Mohammad-Hossein Kaveh
- Department of Health Promotion, School of Health, Shiraz University of Medical Science, Shiraz, Iran
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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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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: 64] [Impact Index Per Article: 8.0] [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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