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At least 127 records · Page 7Linked to original sources
PubMed1992

Isoflurane anaesthesia in the treatment of convulsive status epilepticus. Case report.

Status epilepticus may be resistant to intravenous anticonvulsive drugs. In these cases treatment with the inhalation anaesthetic agent isoflurane may be helpful in the further management. We describe a 35-year-old female patient who suffered from status epilepticus with partial seizures. In spite of therapy with benzodiazepine and phenytoin the status evolved into tonic clonic seizures. Treatment with thiopentone sodium did not stop seizure activity. Anaesthesia with isoflurane (dosage up to 1.5 vol.%) carried out twice within 72 h finally led to a termination of status epilepticus. From our own experience and reports in the literature we conclude that general anaesthesia with isoflurane can and should be used in the treatment of severe status epilepticus that does not respond to intravenous anticonvulsive agents.

Adult↗
PubMed1999

Cat-scratch disease causing status epilepticus in children.

Status epilepticus from cat-scratch encephalopathy is often recalcitrant to usual therapies, causing treatment to focus on critical care management of the patient that may require aggressive interventions, such as continuous pentobarbital administration. We describe two children whose initial clinical presentation of cat-scratch disease was status epilepticus with normal cerebrospinal fluid studies. A history of cat exposure (specifically, kitten and/or fleas), regional lymphadenopathy, and a papule or inoculation site should be sought, but are not essential for diagnosis. The presumptive diagnosis of cat-scratch disease can be made by serology alone even in the absence of classic diagnostic criteria. Our two cases and other reports in the literature show a favorable prognosis in most cases, despite the occurrence of status epilepticus. The diagnosis of cat-scratch disease should be strongly considered in all children with unexplained status epilepticus or encephalopathy and serologic testing for Bartonella henselae should be done.

Cat-Scratch Disease↗
PubMed1995

Permanent hemiparesis due to partial status epilepticus.

Partial status epilepticus (SE) produces permanent focal neurologic deficits if it lasts for months or is associated with systemic illness or CNS inflammation. We describe a patient in focal SE for just 5 days. Attacks were her habitual frontal lobe seizures. When SE stopped, permanent contralateral hemiparesis was present. There was no new cause for the weakness except the SE itself. We conclude that partial SE requires prompt and effective treatment, since it can lead to permanent neurologic dysfunction.

Accidental Falls↗
PubMed2002

Lack of neuronal damage in atypical absence status epilepticus.

PURPOSE: Whether status epilepticus of nonconvulsive epileptic seizures is harmful still remains controversial. To investigate this, the presence and/or extent of neuronal damage in patients with absence status epilepticus (ASE) and patients with complex partial status epilepticus (CPSE) was examined and compared. METHODS: Neuron-specific enolase (NSE) in CSF was examined in the patients with ASE and compared with that of the patients having CPSE. Clinical aspects of these patients also were investigated. RESULTS: CSF NSE levels in ASE patients were lower than those of CPSE patients and were considered as the normal values. No clinical symptoms indicated neuronal damage in the ASE patients. CONCLUSIONS: This study suggests that ASE does not induce neuronal damage. Serum NSE is not always correlated to CSF NSE, and determination of serum NSE levels may be an inappropriate method of estimating neuronal damage in some cases of ASE.

Adolescent↗
PubMedDate not supplied

Oculoclonic status epilepticus.

Continuous oculoclonic status epilepticus occurred for 90 min in a 4-year-old girl. The seizure consisted of continuous contralateral horizontal nystagmus concurrent with left occipital spike discharges, occasional vomiting and no loss of consciousness. Oculoclonic status epilepticus may be a variant form of versive status epilepticus.

Anticonvulsants↗
PubMed2002

Treatment of status epilepticus in children.

Status epilepticus is a medical emergency that requires prompt recognition and urgent treatment. Successful management of status epilepticus in children depends upon implementation of a treatment protocol modified according to current practices as well as availability of antiepileptic medications, out of hospital emergency services and intensive-care facilities. We propose a treatment protocol for status epilepticus in children in the Kingdom of Saudi Arabia.

Child↗
PubMed1997

[Differential traits of non-convulsive status epilepticus].

Non convulsive status epilepticus (NCSE) is defined by prolonged loss of awareness and epileptiform activity on electroencephalogram. There are several types of NCSE depending of the clinical and electroencephalographic manifestations: generalized (typical or atypical absence status, status epilepticus during sleep) and partial (complex partial and simple partial status epilepticus). NCSE diagnosis and treatment should be performed early due to the potential brain damage associated to it, specially in complex partial NCSE. Accurate differential diagnosis from other imitators of NCSE (psychogenic seizures, metabolic encephalopaties or antiepileptic drug intoxication) is necessary for early treatment.

Anticonvulsants↗
PubMed1978

Drug therapy reviews: drug therapy of status epilepticus.

Drug treatment of status epilepticus is reviewed. Tonic-clonic, focal motor, complex partial and absence status epilepticus are discussed. In managing tonic-clonic status epilepticus one should: (1) maintain vital functions at all times, (2) identify and treat precipitating factors and (3) administer an intravenous loading dose of phenytoin sodium or phenobarbital sodium. Careful use of i.v. diazepam sometimes helps to achieve these objectives. Intravenous phenytoin sodium and phenobarbital sodium provide definitive, long-term control of tonic-clonic seizures but must be administered slowly and require time to reach peak brain concentrations. Intravenous diazepam appears to enter and exit from the brain rapidly and may control seizures while therapeutic brain concentrations of long-acting drugs are being achieved. Phenytoin, phenobarbital and diazepam should not be administered intramuscularly in treating status epilepticus. Treatment of focal motor and complex partial status epilepticus is similar to that of tonic-clonic status epilepticus, but i.v. diazepam is required less frequently and loading doses of phenytoin and phenobarbital sometimes can be given more slowly. Status epilepticus of the absence type is managed with i.v. acetazolamide sodium or diazepam. Paraldehyde, muscle relaxants, general anesthesia and lidocaine may be tried when conventional therapies fail.

Anesthesia, General↗
PubMed1997

[Simple partial frontal nonconvulsive status epilepticus].

Non convulsive status epilepticus (NCSE) of frontal origin is a rare cause of mental confusion. The present case of possible frontal-onset NCSE proved to have a neuropsychological examination that was suggestive either of a disruption of attentional function or a left prefrontal dysfunction, exhibiting disturbances of immediate memory and logical programmation, perseverations and affective disinhibition. Vigilance was not impaired. This case was therefore, on a nosographic point of view, more consistent with a simple partial status epilepticus with cognitive and affective symptomatology rather than with a complex partial status epilepticus of extra-temporal origin.

Electroencephalography↗
PubMed1999

Status epilepticus: current concepts.

Status epilepticus (SE) is a common pediatric emergency encountered in the prehospital situations and in the emergency administration of anticonvulsants, which will cause the seizures to cease. Although prognosis is primarily determined by the etiology, the duration of SE and therapy administered have unequivocal impact. If the seizures last longer than 1 hour, homeostatic mechanisms may start to fail. A dynamic multidisciplinary approach is essential in seizure management. The emergency physician has a unique responsibility to provide state-of-the art therapy and individualize the involvement of other services. The input of the pediatric intensive care physician is critical and assumes a major role if the patient fails to respond to first-line therapy. The treatment of refractory status epilepticus requires labor-intensive hemodynamic support and suppression of central nervous system, with either an anesthetic agent or a barbiturate. There is an urgent need to formulate guidelines for management of refractory status epilepticus.

Anticonvulsants↗
PubMed1996

Generalized convulsive status epilepticus.

Generalized convulsive status epilepticus (GCSE) is a medical emergency that may be associated with severe neuronal injury. The mortality attributable to GCSE ranges from 3 to 35%. The disorder occurs most frequently in the young and the old extremes of the population. GCSE commonly occurs in patients with no history of seizures or epilepsy. The morbidity associated with status epilepticus is related to the underlying precipitating factors, age of the patient, and duration of seizure activity. Morbidity and mortality are highest in elderly patients and those with acute symptomatic seizures--for example, GCSE related to anoxia or cerebral infarction. Mortality is lowest among pediatric patients and patients with unprovoked seizures or GCSE related to low antiepileptic drug levels. Intravenously administered diazepam or lorazepam and phenytoin remain the first-line therapy for GCSE. More than half the patients will respond to initial treatment. Patients with refractory status epilepticus require a physician with expertise in epilepsy. Treatment options include pentobarbital, high-dose phenobarbital, or inhalation anesthetic agents.

Adolescent↗
PubMed1998

Use of midazolam for refractory status epilepticus in pediatric patients.

Status epilepticus is more common among children than young adults. Children might be less likely to die and might be resistant to permanent neurologic damage due to status epilepticus, but significant sequelae also have been demonstrated. Aggressive intervention and rapid termination of seizures contribute significantly to better prognosis and reduced mortality from status epilepticus. Initial treatment of status epilepticus typically consists of either diazepam or lorazepam, immediately followed by phenytoin or phenobarbital. However, approximately 100% to 15% of status epilepticus episodes are refractory to these conventional therapies. Traditionally, refractory status epilepticus is treated with barbiturate coma or general anesthetics, both of which require invasive cardiorespiratory and hemodynamic monitoring and are associated with significant complications. Midazolam is a water-soluble benzodiazepine with a fast onset of action, a short half-life, and inactive metabolites that has been very effective in terminating seizures refractory to diazepam, lorazepam, phenytoin, and phenobarbital in pediatric patients. Midazolam is a valuable treatment option for refractory status epilepticus, especially in pediatric patients.

Anti-Anxiety Agents↗
PubMed1997

Status epilepticus.

Generalised convulsive status epilepticus is a medical emergency. Knowledge of the pathophysiology of status epilepticus and the pharmacology of the medications used to treat it allow one to devise a rational protocol for management. Anticipation of medical complications facilitates intervention when required. Prognosis depends largely on the underlying causes.

Anticonvulsants↗
PubMed1988

Very-high-dose phenobarbital for refractory status epilepticus in children.

Status epilepticus refractory to initial anticonvulsant therapy is a serious condition with a high morbidity and mortality. We present 50 cases with refractory status epilepticus (RSE) treated with very-high-dose phenobarbital (VHDPB) without reference to a predetermined maximum level or dose. Maximum serum levels ranged from 70 to 344 micrograms/ml (median, 114 micrograms/ml). VHDPB controlled seizures in all cases where no limits were imposed upon maximum dose (47/50). We found no maximum dose beyond which further doses are likely to be ineffective. Forty patients were intubated prior to VHDPB, but recovered respiratory drive and could be removed from the ventilator despite very high serum levels. This is explained by acute drug tolerance. Hypotension was unusual, related to the highest levels, and easily controlled. VHDPB has many relative advantages over other therapies presently used for RSE.

Blood Pressure↗
PubMed1996

Stopping status epilepticus.

Generalised convulsive status epilepticus (GCSE) is a medical emergency. The mortality in patients with GCSE admitted to an intensive care unit is about 5-10%. If figures for the USA can be applied to the UK, about 30,000 episodes of status epilepticus occur here each year. In this article we discuss the management of GCSE, concentrating on ways of stopping an episode.

Anticonvulsants↗
PubMed2006

Endocannabinoids block status epilepticus in cultured hippocampal neurons.

Status epilepticus is a serious neurological disorder associated with a significant morbidity and mortality. Antiepileptic drugs such as diazepam, phenobarbital and phenytoin are the mainstay of status epilepticus treatment. However, over 20% of status epilepticus cases are refractory to the initial treatment with two or more antiepileptic drugs. Endocannabinoids have been implicated as playing an important role in regulating seizure activity and seizure termination. This study evaluated the effects of the major endocannabinoids methanandamide and 2-arachidonylglycerol (2-AG) on status epilepticus in the low-Mg(2+) hippocampal neuronal culture model. Status epilepticus in this model was resistant to treatment with phenobarbital and phenytoin. Methanandamide and 2-AG inhibited status epilepticus in a dose-dependent manner with an EC(50) of 145+/-4.15 nM and 1.68+/-0.19 microM, respectively. In addition, the anti-status epilepticus effects of methanandamide and 2-AG were mediated by activation of the cannabinoid CB(1) receptor since they were blocked by the cannabinoid CB(1) receptor antagonist AM251. These results provide the first evidence that the endocannabinoids, methanandamide and 2-AG, are effective inhibitors of refractory status epilepticus in the hippocampal neuronal culture model and indicate that regulating the endocannabinoid system may provide a novel therapeutic approach for treating refractory status epilepticus.

Animals↗
PubMed1983

Treatment of status epilepticus in children.

Status epilepticus is a medical emergency requiring immediate treatment. General treatment is aimed at restoring physiologic homeostasis, and drug therapy is aimed at arresting the convulsive activity and preventing its recurrence. Concurrent administration of diazepam and either phenytoin or phenobarbital will be effective in most cases. After the status epilepticus has been treated the underlying cause should be investigated and, if possible, treated.

Anticonvulsants↗