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Query: UMLS:C0038220 (status epilepticus)
 7,272 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe the development of temporal lobe epilepsy in an 84-year-old man who had suffered domoic acid intoxication. Following intoxication he had nausea, vomiting, confusion, and coma. Generalized convulsions and complex partial status epilepticus progressively developed. After 3 weeks he improved and was seizure free with severe residual memory deficit. Electroencephalograms initially showed periodic epileptiform discharges, later evolving to epileptic abnormalities over frontotemporal regions with diffuse slow waves. Eight months after the intoxication the electroencephalogram was normal. One year after the acute episode, complex partial seizures developed. Electroencephalograms showed epileptic discharges independently over both temporal lobes, with left-sided predominance. Magnetic resonance imaging revealed a hyperintense T2-weighted signal and atrophy of both hippocampi; a positron emission tomographic scan showed bitemporal decreased glucose metabolism. Pneumonia developed and the patient died 3 1/4 years after the intoxication. Autopsy disclosed severe bilateral hippocampal sclerosis. The seizures following acute domoic acid intoxication, the postmortem pathology, and the fact that temporal lobe epilepsy developed 1 year after intoxication indicate that the human hippocampus is also vulnerable to kainate receptor excitotoxicity, and provide strong evidence supporting the role of excitotoxic injury in epileptogenesis. This report provides a unique human parallel to, and validates the animal model of, kainate-induced epilepsy as an important tool for studying temporal lobe epilepsy.
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PMID:Temporal lobe epilepsy caused by domoic acid intoxication: evidence for glutamate receptor-mediated excitotoxicity in humans. 781 46

Patients with GCSE and NCSE are common and may present to the emergency department or the NICU. In the NICU, NCSE is a more common presentation than GCSE. In the emergency department, GCSE commonly evolves to NCSE, either as a late sequela of prolonged SE or due to partial treatment with antiepileptic medication or neuromuscular blocking agents. In the emergency department, acute cerebral injuries are commonly found in patients presenting with SE, regardless of whether they have preexisting epilepsy. In the NICU, almost by definition, SE occurs in patients with acute cerebral injuries. Status epilepticus has been found to evolve sequentially through several stages, the end-point of which is a condition of refractory SE leading to neuronal necrosis and permanent cerebral injury. The responsiveness of SE to treatment is time-dependent. This makes early diagnosis and initiation of treatment essential. Most published treatment algorithms stress a 60-minute time window from the diagnosis of SE to its successful control. Unfortunately, the practical problem of patients with SE accessing such treatment protocols has been overlooked. Our preliminary (unpublished) data suggest that this access problem must be solved for treatment algorithms to improve the outcome of SE. In the NICU, access is less of a problem, and the determining factor is early diagnosis by NICU personnel. Because these patients usually sustain NCSE, which can be difficult to diagnose, a high index of suspicion and, optimally, continuous EEG monitoring are necessary for early diagnosis. NICU patients may be more susceptible to the ravages of SE because of their preexisting cerebral injuries. Expedited treatment may therefore be more important in this patient group. Clinical management of SE requires meticulous attention to ventilation and oxygenation, maintenance of adequate blood pressure, prevention of hyperthermia, and close monitoring for cardiac abnormalities. No specific medication is ideal for controlling SE. The knowledgeable and prompt use of intravenous lorazepam, a diazepam-phenytoin combination, or phenobarbital is acceptable as first-line treatment and as part of a systematic treatment algorithm. Refractory SE has been treated conventionally with high-dose intravenous barbiturate coma. Recent evidence suggests that high-dose intravenous midazolam may provide a useful alternative.
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PMID:Status epilepticus. A perspective from the neuroscience intensive care unit. 782 78

We reviewed clinical features of 48 patients without prior epilepsy who had generalized electrographic status epilepticus (ESE) identified from EEG readings. Clinical status epilepticus (SE) had occurred in 40%, but most were thought to have stopped seizing. Overall, ESE was unsuspected in 81% of patients. Many types of seizures were present before the EEG, but clinical seizures recurred in only 17 patients after diagnosis, and 18 patients (38%) never had clinical evidence of seizures. Most patients (60%) were comatose. The cause of ESE often remained uncertain though many patients had serious medical illnesses. Eighty-eight percent died, and a poor outcome was predicted by coma at the time of diagnosis (29 of 29), anoxia (15 of 15), an invariantly discharging, low-voltage background EEG (15 of 16), and refractory electrographic or clinical seizures (29 of 31). Seizure type did not predict outcome, and mortality was as high for patients without clinical evidence of seizures (89%) as for the series as a whole. ESE is often unanticipated and signifies neurologic disease with a prognosis worse than convulsive SE or the typical nonconvulsive SE; the absence of clinical seizures confers no advantage.
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PMID:Clinical implications of generalized electrographic status epilepticus. 784 66

Patients with systemic cancer may have altered mental status without evidence of metastases, strokes, or metabolic encephalopathies. Six such patients are described whose EEGs showed continuous generalized epileptiform discharges in the absence of clinical signs of seizures. Two patients had never had any clinical evidence of seizures, and four had seizures that were thought to have stopped before the EEG. Three patients were confused, and three were stuporous or comatose. In some patients the nonconvulsive epileptic activity may have been directly related to the cancer; three had findings suggestive of possible paraneoplastic encephalopathies. Anticonvulsants led to an improved mental status in four patients, but all except one died. Nonconvulsive generalized status epilepticus may explain altered mental status in some patients with cancer, and anticonvulsant medication treatment can be beneficial.
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PMID:Nonconvulsive status epilepticus in patients with cancer. 788 94

Status epilepticus with generalized seizures may sometimes develop in epileptic patient who does not recover between attacks. Such a state is life-threatening and requires immediate intervention. Own experience with 22 patients suffering from status epilepticus out of 100 epileptic patients treated at the hospital. Management of status epilepticus is also discussed. Diazepam should be given intravenously or clonazepam with phenytoin as the drugs of the first choice. Then, barbiturates are given to produce coma. If the disease is progressing, the third choice drugs are also discussed.
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PMID:[Status epilepticus: clinical features, causes and management]. 802 34

A previously healthy 22-month-old boy presented in status epilepticus with high fever. He was comatose, with upper respiratory-tract infection. The seizures responded to anticonvulsant therapy. The boy's temperature returned to normal within 24 hours and he recovered slowly from his encephalopathy. On the third hospital day, he exhibited the characteristic rash of reseola infantum. Acute infection with human herpes virus 6 (HHV-6) was established serologically by enzyme immunoassay. HHV-6 DNA was not detected by polymerase chain reaction in CSF or serum at the onset of illness, but was found three months later in the child's saliva. The pathogenesis of the patient's encephalopathy is discussed. It is concluded that HHV-6 infection should be considered in infants and young children with febrile status epilepticus.
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PMID:Acute encephalopathy and status epilepticus associated with human herpes virus 6 infection. 803 28

A 4-year-old girl with status epilepticus and severe encephalopathy associated with cat-scratch disease is described. She had prolonged seizures lasting more than 2 weeks and required treatment with pentobarbital coma. She developed unusual abnormalities on magnetic resonance imaging scans that involved the thalami and the cortex of the temporal, parietal, and occipital lobes. She has developed a persistent encephalopathy manifesting as visual disturbance and frequent partial seizures.
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PMID:Unusual MRI findings after status epilepticus due to cat-scratch disease. 806 Apr 32

A nearly four-year-old boy awoke blind, deaf and mute from a coma of five days duration after a status epilepticus caused by hyperpyrexia from shigellosis. The authors give a detailed report of the recovery. Visual and auditory functions recovered within six months after the onset but expressive language difficulties remained. Following a discussion of the underlying mechanisms producing the cerebral damage, the hypothesis of a type of "disconnection syndrome" is put forward to explain the persisting language deficit.
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PMID:Blind, deaf and mute after a status epilepticus caused by hyperpyrexia from shigellosis--a case report with a four-year follow-up. 813 83

As with other methods long used in intensive care units (ICU) and operating rooms (OR), the goal of neuroscience ICU continuous EEG (NICU-CEEG) and evoked potential (NICU-EP) monitoring is to extend our powers of observation to detect abnormalities at a reversible stage. EEG is an appropriate monitoring tool because it is linked to cerebral metabolism, is sensitive to ischemia and hypoxemia, correlates with cerebral topography, detects neuronal dysfunction at a reversible stage, and is the best method for detecting seizure activity. When applied systematically, it can impact medical decision-making in 81% of monitored patients. It is useful in monitoring precarious cerebral perfusion at the bedside, and it has revealed that nonconvulsive seizures, undetectable otherwise, occur in 34% of NICU patients. In convulsive status epilepticus, NICU-CEEG can help avoid undertreatment and overtreatment. In comatose patients, it can provide useful prognostic information as well as detect potentially treatable causes. Traditional impediments to its application are yielding to technological advances and educational efforts. Real-time digitized EEG in particular has been a major advance. Within limits, somatosensory evoked potential monitoring (ICU-SEP) is useful in the prognosis of coma, but it is less helpful in monitoring focal cerebral ischemia. Brainstem auditory evoked potential monitoring has a relatively restricted role in the NICU but is helpful in distinguishing structural from nonstructural causes of coma and can supplement ICU-SEP in predicting outcome.
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PMID:Continuous EEG and evoked potential monitoring in the neuroscience intensive care unit. 830 43

A case is reported of a duodenal perforation by a Kimray-Greenfield filter hook in a 66-year-old female patient. This device had been inserted four years before, after a pulmonary embolism. The patient presented with epigastric pain, vomiting and extracellular dehydration with renal failure. A plain abdominal film showed the filter to be tilted 15 degrees to the left, with an opening 28 mm wide. Various investigations were carried out, none of which providing a satisfactory diagnosis. Steroid treatment (1 mg.kg-1 x day-1 of prednisone) was started before admission to intensive care. Only at that time gastroduodenoscopy showed on of the filter's hooks jutting through the duodenal wall. This perforation was located in the posterior wall of the third part of the duodenum, and was associated with an ulcer of the mucosa facing this hook. The diagnosis was confirmed by an abdominal CT scan. The hook was cut and the perforation sealed off during a first laparotomy. Twenty-six days later, the patient developed intestinal obstruction due to a haematoma of the jejunal wall. She later had a cerebrovascular accident, with status epilepticus and deep coma. She died four months after her admission. The late complications of vena caval filters are discussed. The position of these devices should be regularly checked by a plain abdominal film. Abdominal CT scanning is a useful investigation for the diagnosis of intra and extravascular complications.
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PMID:[Duodenal perforations by the hooks of a Kimray-Greenfield filter]. 833 71


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