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Deng B, Dai Y, Wang Q, Yang J, Chen X, Liu TT, Liu J. The clinical analysis of new-onset status epilepticus. Epilepsia Open 2022; 7:771-780. [PMID: 36214088 PMCID: PMC9712477 DOI: 10.1002/epi4.12657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 10/07/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To investigate and analyze the etiology and prognosis of patients with new-onset status epilepticus (NOSE). METHODS We conducted a retrospective analysis of all adult patients (≧16 years old) who were admitted to Sichuan Provincial People's Hospital between January 2018 and December 2020 with status epilepticus (SE) and no prior epilepsy history. RESULTS We collected data from 85 patients, aged from 16 to 90 years, of whom 49 were male and 36 were female. Fifty-five of these cases (64.7%) were younger than 60 years of age. Acute symptomatic SE was mostly seen in the NOSE (53.9%), followed by unknown SE (25.9%), progressive SE (11.8%), and remote SE (9.4%). The differences in the etiology of NOSE between age groups were statistically significant (P < .05). For the young, the main etiology remained unknown (36.3%), followed by autoimmune-related SE (16.4%); in the elderly, the primary etiology was central nervous system (CNS) infection (23.3%), followed by cerebrovascular disease (20%), and intracranial tumors (20%). Normal imaging was mostly seen in young people with NOSE (P < .001). Regarding outcome parameters and risk factors in patients with NOSE, adverse outcome was associated with age (OR = 3.5, 95% CI = 0.108-0.758, P = .012), co-infection (OR = 4.5, 95% CI = 0.083-0.599, P = .003), and tracheal intubation (OR = 6.318, 95% CI = 0.060-0.204, P = .011). SIGNIFICANCE In our cohort, intracranial tumors, CNS infections, and cerebrovascular disease were the predominant causes of NOSE in the elderly, while autoimmune encephalitis was the largest recognized cause of NOSE in young patients. In addition, imaging varies with age. According to the data, preventing infections may enhance patient prognosis because greater infection rates are connected with less favorable results. Meanwhile, age and mechanical ventilation are related to the prognosis of NOSE.
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Affiliation(s)
- Binlu Deng
- Southwest Medical University, Luzhou, China
| | - Yuqian Dai
- School of Medicine, St. George's University, St. George, Grenada
| | - Qi Wang
- Southwest Medical University, Luzhou, China
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiang Chen
- Southwest Medical University, Luzhou, China
| | - Ting-Ting Liu
- Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jie Liu
- Southwest Medical University, Luzhou, China.,Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Osuntokun OS, Olayiwola G, Adekomi DA, Oyeyipo IP, Ayoka AO. Proanthocyanidin from Vitis vinifera attenuates memory impairment due to convulsive status epilepticus. Epilepsy Behav 2021; 124:108333. [PMID: 34619539 DOI: 10.1016/j.yebeh.2021.108333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022]
Abstract
This study investigated the effects of proanthocyanidin-rich fraction (PRF) of Vitis vinifera seed extract on the markers of hippocampal-dependent memory in convulsive status epilepticus (CSE) rat model. One hundred juvenile Wistar rats were randomized into 6 groups. Group 1 (n = 10) received propylene glycol (PG 0.1 ml/100 g) intraperitoneally (i.p), while convulsion was induced in groups 2-6 (n = 18 each) using lithium (127 mg/kg i.p) and pilocarpine hydrochloride (40 mg/kg i.p). The established CSE rats in groups 2-6 received a daily treatment of PG (0.1 ml i.p), PRF (30 mg/kg i.p), PRF (20 mg/kg BW i.p), PRF (10 mg/kg BW i.p) or diazepam (5 mg/kg BW i.p) for seven days. Thereafter, they were kept untreated but with access to feed and water for 21 days. The control and CSE-treated rats were subjected to behavioral tests, while the biochemical and histomorphological evaluations of the hippocampus were done after the sacrifice. The results were presented as mean ± SEM in graphs or tables. The level of significance was considered when p < 0.05. There was significant decrease in the hippocampal-dependent memory, hippocampal weight and an increased malondialdehyde concentration following CSE. The activities of acetylcholinesterase decreased significantly in the PRF-treated CSE rats. The hippocampal glial cells and granule count increased significantly following CSE, with various neurodegenerative features in the CA1 of the hippocampus. These derangements were attenuated significantly following PRF treatment. Memory impairment following CSE may be attenuated with the administration of PRF from V. vinifera seed in rats.
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Affiliation(s)
- Opeyemi Samson Osuntokun
- Department of Physiology, Faculty of Basic Medical Sciences, Osun State University Osogbo, Nigeria; Department of Physiological Sciences, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
| | - Gbola Olayiwola
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | | | - Ibukun Peter Oyeyipo
- Department of Physiology, Faculty of Basic Medical Sciences, Osun State University Osogbo, Nigeria
| | - Abiodun Oladele Ayoka
- Department of Physiological Sciences, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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Comparison of the efficacy and safety of levetiracetam and phenytoin in the treatment of established status epilepticus: A systematic review and meta-analysis. J Clin Neurosci 2021; 89:422-429. [PMID: 34053822 DOI: 10.1016/j.jocn.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/21/2021] [Accepted: 05/02/2021] [Indexed: 12/14/2022]
Abstract
Status epilepticus (SE) is the second most critical neurological illness after cerebrovascular disease. Phenytoin has traditionally been considered the second-line drug of first choice after failure of first-line treatment using benzodiazepines. In recent years, levetiracetam has been proposed as a potential substitute for phenytoin. To comprehensively evaluate the efficacy and safety of levetiracetam and phenytoin in the treatment of patients with established SE, we integrated the data from 11 eligible studies and conducted a systematic review and meta-analysis. The PubMed, Web of Science, Cochrane Library, and Embase databases were searched to identify eligible articles reporting outcomes including clinical seizure cessation within 60 min, clinical recurrence rate within 24 h, good final outcome at discharge, and adverse events (AEs) of treatment with levetiracetam and phenytoin. Our study included a total of 11 trials including a total of 1933 patients. The outcomes showed that the pooled Risk Raito (RR) of clinical seizure cessation within 60 min was 1.08 (95% CI = 1.02-1.14, P = 0.01). The pooled RR of clinical recurrence rate within 24 h was 1.03 (95% CI = 0.66-1.59, P = 0.91). The pooled RR of AEs was 0.83 (95% CI = 0.57-1.21, P = 0.34). The pooled RRs of life-threatening hypotension and acute respiratory depression were 0.29 (95% CI = 0.10-0.81, P = 0.02) and 0.63 (95% CI = 0.40-0.98, P = 0.04), respectively. Levetiracetam might be more effective than phenytoin for the treatment of established SE and is associated with a lower incidence of more serious AEs. Levetiracetam can be used as an alternative to phenytoin for the treatment of benzodiazepine-refractory SE.
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A Fast-Track Care by a Nursing Case Management Concept Improved Status Epilepticus Outcomes. J Neurosci Nurs 2021; 52:200-204. [PMID: 32541355 DOI: 10.1097/jnn.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Status epilepticus (SE) is an emergency neurological condition, which is life-threatening, results in high morbidity and mortality rates, and needs to be diagnosed and promptly cared for. This study aimed to develop and evaluate the SE fast-track care using a nursing case management concept on SE outcomes. METHODS Quasi-experimental study conducted in adult patients with SE admitted in 15 emergency and intensive critical/intermediate care wards. SE outcomes were evaluated and compared between preintervention and postintervention. RESULTS Time to treatment was reduced from 30 minutes to 3.5 minutes (P < .001). Similarly, the seizure control rate increased from 65.7% to 94.4% (P = .009). The mortality rate was reduced but did not reach statistical significance (8.6% vs 0%; P = .115). The intervention also reduced average waiting time for receiving antiepileptic drugs from the pharmacy department from 13.09 minutes to < 1 minute. CONCLUSION The development of the fast-track care system for SE patients by nursing case management is at the core of management for coordinating multidisciplinary teams. This can improve outcomes by reducing the time to diagnosis and treatment time, therefore reducing mortality rates in SE patients.
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Chen YS, Chen TS, Huang CW. Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency. Heliyon 2020; 6:e05376. [PMID: 33209999 PMCID: PMC7658694 DOI: 10.1016/j.heliyon.2020.e05376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/10/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022] Open
Abstract
Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and appropriate treatment is not given. Herein, we report a case with NCSs misdiagnosed as vertebrobasilar insufficiency (VBI), in which the patient suffered from episodes of prominent dizziness, vertigo, becoming transfixed, and worsening response within a day. Brain magnetic resonance image findings were unremarkable, however electroencephalography (EEG) showed rhythmic epileptiform discharges that appeared to originate from the right frontal area with ipsilateral hemispheric involvement. We prescribed intravenous valproate and the seizures ceased. Few studies have reported a patient with NCS misdiagnosed with VBI, a very different entity. It is thus important that clinicians should be aware of the trivial symptoms of NCSs, and to consider implementing early EEG studies and anti-epileptic drug therapy.
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Affiliation(s)
- Yu-Shiue Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsang-Shan Chen
- Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan
| | - Chin-Wei Huang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Zhou X, Chen Q, Huang H, Zhang J, Wang J, Chen Y, Peng Y, Zhang H, Zeng J, Feng Z, Xu Z. Inhibition of p38 MAPK regulates epileptic severity by decreasing expression levels of A1R and ENT1. Mol Med Rep 2020; 22:5348-5357. [PMID: 33174009 PMCID: PMC7647013 DOI: 10.3892/mmr.2020.11614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022] Open
Abstract
Epilepsy is a chronic nervous system disease. Excessive increase of the excitatory neurotransmitter glutamate in the body results in an imbalance of neurotransmitters and excessive excitation of neurons, leading to epileptic seizures. Long‑term recurrent seizures lead to behavior and cognitive changes, and even increase the risk of death by 2‑ to 3‑fold relative to the general population. Adenosine A1 receptor (A1R), a member of the adenosine system, has notable anticonvulsant effects, and adenosine levels are controlled by the type 1 equilibrative nucleoside transporter (ENT1); in addition the p38 MAPK signaling pathway is involved in the regulation of ENT1, although the effect of its inhibitors on the expression levels of A1R and ENT1 is unclear. Therefore, in the present study, SB203580 was used to inhibit the p38 MAPK signaling pathway in rats, and the expression levels of A1R and ENT1 in the brain tissue of rats with acute LiCl‑pilocarpine‑induced status epilepticus was detected. SB203580 decreased pathological damage of hippocampal neurons, prolonged seizure latency, reduced the frequency of seizures, and decreased levels of A1R and ENT1 protein in rats.
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Affiliation(s)
- Xuejiao Zhou
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Qian Chen
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Hao Huang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Jun Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Jing Wang
- Department of Prevention and Health Care, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Ya Chen
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Yan Peng
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Haiqing Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Junwei Zeng
- Department of Physiology, Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
| | - Zhanhui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou 550004, P.R. China
| | - Zucai Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563003, P.R. China
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Wyatt-Johnson SK, Herr SA, Brewster AL. Status Epilepticus Triggers Time-Dependent Alterations in Microglia Abundance and Morphological Phenotypes in the Hippocampus. Front Neurol 2017; 8:700. [PMID: 29326654 PMCID: PMC5741821 DOI: 10.3389/fneur.2017.00700] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/06/2017] [Indexed: 12/30/2022] Open
Abstract
Status epilepticus (SE) is defined by the occurrence of prolonged “non-stop” seizures that last for at least 5 min. SE provokes inflammatory responses including the activation of microglial cells, the brain’s resident immune cells, which are thought to contribute to the neuropathology and pathophysiology of epilepsy. Microglia are professional phagocytes that resemble peripheral macrophages. Upon sensing immune disturbances, including SE, microglia become reactive, produce inflammatory cytokines, and alter their actin cytoskeleton to transform from ramified to amoeboid shapes. It is widely known that SE triggers time-dependent microglial expression of pro-inflammatory cytokines that include TNFα and IL-1β. However, less is known in regards to the spatiotemporal progression of the morphological changes, which may help define the extent of microglia reactivity after SE and potential function (surveillance, inflammatory, phagocytic). Therefore, in this study, we used the microglia/macrophage IBA1 marker to identify and count these cells in hippocampi from control rats and at 4 h, 3 days, and 2 weeks after a single episode of pilocarpine-induced SE. We identified, categorized, and counted the IBA1-positive cells with the different morphologies observed after SE in the hippocampal areas CA1, CA3, and dentate gyrus. These included ramified, hypertrophic, bushy, amoeboid, and rod. We found that the ramified phenotype was the most abundant in control hippocampi. In contrast, SE provoked time-dependent changes in the microglial morphology that was characterized by significant increases in the abundance of bushy-shaped cells at 4 h and amoeboid-shaped cells at 3 days and 2 weeks. Interestingly, a significant increase in the number of rod-shaped cells was only evident in the CA1 region at 2 weeks after SE. Taken together, these data suggest that SE triggers time-dependent alterations in the morphology of microglial cells. This detailed description of the spatiotemporal profile of SE-induced microglial morphological changes may help provide insight into their contribution to epileptogenesis.
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Affiliation(s)
- Season K Wyatt-Johnson
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Seth A Herr
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Amy L Brewster
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States.,Weldon School of Biomedical Engineering, West Lafayette, IN, United States
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Status epilepticus triggers long-lasting activation of complement C1q-C3 signaling in the hippocampus that correlates with seizure frequency in experimental epilepsy. Neurobiol Dis 2017; 109:163-173. [PMID: 29074125 DOI: 10.1016/j.nbd.2017.10.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/30/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023] Open
Abstract
Status epilepticus (SE) triggers a myriad of neurological alterations that include unprovoked seizures, temporal lobe epilepsy (TLE), and cognitive deficits. Although SE-induced loss of hippocampal dendritic structures and synaptic remodeling are often associated with this pathophysiology, the underlying mechanisms remain elusive. Recent evidence points to the classical complement pathway as a potential mechanism. Signaling through the complement protein C1q to C3, which is cleaved into smaller biologically active fragments including C3b and iC3b, contributes to the elimination of synaptic structures in the normal developing brain and in models of neurodegenerative disorders. We recently found increased protein levels of C1q and iC3b fragments in human drug-resistant epilepsy. Thus, to identify a potential role for C1q-C3 in SE-induced epilepsy, we performed a temporal analysis of C1q protein levels and C3 cleavage in the hippocampus along with their association to seizures and hippocampal-dependent cognitive functions in a rat model of SE and acquired TLE. We found significant increases in the levels of C1q, C3, and iC3b in the hippocampus at 2-, 3- and 5-weeks after SE relative to controls (p<0.05). In the SE group, greater iC3b levels were significantly correlated with higher seizure frequency (p<0.05). Together, these data support that hyperactivation of the classical complement pathway after SE parallels the progression of epilepsy. Future studies will determine whether C1q-C3 signaling contributes to epileptogenic synaptic remodeling in the hippocampus.
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