Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0038220 (status epilepticus)
 7,272 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Status epilepticus is a rare complication of conventional single-stimulus electroconvulsive therapy (ECT). We report a case of ECT-induced nonconvulsive generalized status epilepticus (NGS) that lasted 3.5 days. The patient showed regressed psychotic behavior coupled with waxing and waning mutism and unresponsiveness as well as subtle unilateral motor signs. The diagnosis of NGS requires electroencephalographic confirmation.
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PMID:Generalized nonconvulsive status epilepticus after electroconvulsive therapy. 779 69

506 patients with schizophrenia, diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) criteria, were included in a long term treatment programme with remoxipride, a selective dopamine (D2)-receptor antagonist. This overview includes pooled data from all patients who have been treated long term with remoxipride in clinical trials, focusing on patients treated for more than 6 months (n = 283). Remoxipride was administered in daily doses of 75 to 600mg. The assessment tools were Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Simpson and Angus scale, Abnormal Involuntary Movements Scale (AIMS) for abnormal involuntary movements, adverse events/symptoms using a 26-item checklist, clinical chemistry, and haematology and cardiovascular investigations. The majority of patients had a long duration of illness (median 11 years). 67% of patients (340/506) withdrew from treatment before 12 months and 44% (223/506) stopped treatment before 6 months. The median BPRS total score decreased during the first 3 months from 23 to 12, and this level of improvement was maintained throughout the 12-month period. Treatment-emergent adverse events reported by more than 5% of the patients were insomnia, tiredness, drowsiness and tremor in the group treated for 6 to 12 months. No symptoms, including checklist extrapyramidal symptoms (EPS), were reported by more than 5% of patients treated for 12 months. Low frequencies of EPS according to the Simpson and Angus scale were seen in patients treated for more than 6 months (n = 147). A small but statistically significant reduction of the mean total AIMS score from baseline to last rating was observed. There were infrequent changes in heart rate, resting diastolic blood pressure and electrocardiogram (ECG). Clinical chemistry and haematology data showed no evidence of clinically significant changes over time during the 12 months of treatment. Among 506 patients, 7 suicides and 7 suicide attempts occurred during the study period. Other serious adverse events were abnormal liver function test (2 cases), gastrointestinal, urinary retention, status epilepticus (psychotic polydipsia), granulocytopenia (1 each) and myocardial infarction (5 cases). Remoxipride is of potential value as a drug which is both effective and well tolerated in the long term management of patients with schizophrenia.
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PMID:Tolerability of remoxipride in the long term treatment of schizophrenia. An overview. 832 49

Antagonists of the N-methyl-D-aspartate (NMDA) subtype of glutamate (Glu) receptor have become the focus of considerable attention as potential neurotherapeutic agents in view of mounting evidence implicating NMDA receptors in acute central nervous system (CNS) injury syndromes such as stroke, trauma, and status epilepticus. In addition, NMDA receptor antagonists are of potential interest for the clinical management of neuropathic pain and preventing the development of tolerance to opiate analgesics. A potentially serious obstacle to the development of NMDA antagonists as neurotherapeutic drugs is the paradoxical fact that whereas these agents do have significant neurotherapeutic potential, they also have psychotogenic and neurotoxic properties. We have been intensively investigating the mechanisms underlying these adverse properties and have discovered several methods of suppressing or preventing their expression. In addition, we have been exploring the possibility that a common mechanism may underlie the psychotogenic and neurotoxic actions of these agents and that this mechanism may have relevance to the pathogenesis of idiopathic psychotic processes such as schizophrenia. In this chapter, we will review our findings pertaining to NMDA antagonists in the dual context of their value as tools for exploring mechanisms underlying neuropsychiatric disturbances, particularly schizophrenia, and their potential promise as therapeutic agents. For additional references and a more complete elaboration of our hypothesis pertaining to NMDA receptor dysfunction and schizophrenia, please see a recent review (Olney and Farber 1995).
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PMID:NMDA antagonists as neurotherapeutic drugs, psychotogens, neurotoxins, and research tools for studying schizophrenia. 874 58

With the introduction of several new anticonvulsant drugs into clinical practice in recent years, renewed attention has been paid to treatment-emergent effects, especially behavioural syndromes. In this review, the more severe psychiatric syndromes that may be associated with anticonvulsants are discussed, especially personality disorders, affective syndromes and psychoses. The important concept of forced normalisation is discussed, and its clinical counterpart, alternative psychosis. Affective disorders and psychoses have been described as associated with most of the new anticonvulsant agents, and they are often seen in a setting in which previously intractable patients suddenly become seizure free. Other cases may relate to intoxication, the precipitation of a status epilepticus, or ensue as part of the background frequency of those syndromes that are seen in epilepsy irrespective of medication.
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PMID:Anticonvulsant-induced psychiatric disorders. The role of forced normalisation. 887 70

Reversible bilateral lesions of the claustrum and external capsule in a 12-year-old girl suffering from a severe, transitory encephalopathy are reported. After a prodromal stage of feeling uncomfortable a sudden onset of status epilepticus occurred, followed by recurrent complex partial and myoclonic seizures for 3 weeks, with psychotic symptoms and temporary loss of vision, speech and hearing. After treatment with phenytoin the patient became free of seizures and recovered completely without neurological deficit. The initial cranial CT was normal; however, cranial MRI 7 days later showed bilateral selective lesions of the claustrum and external capsule, which disappeared completely 5 weeks later. The aetiology of these lesions remains obscure; repeated cerebrospinal fluid and blood tests were negative for herpes simplex virus and other infectious agents. The clinical and radiological improvement were concomitant. This may indicate a functional disturbance of the claustrum grey matter, rather than lesions of the white matter of the external and extreme capsules.
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PMID:Severe transitory encephalopathy with reversible lesions of the claustrum. 892 73

The goal of epilepsy monitoring is to capture several seizures, utilizing continuous electroencephalography (EEG)/video for later analysis. Various provocative techniques, such as withdrawing antiepileptic drugs or sleep deprivation are used to precipitate seizures. Patients run a higher risk of injuries due to having an increase in seizure frequency and/or intensity or a change in seizure type. Evaluating the potential for, and preventing injuries is an important part of risk management. However, very little information has been published regarding safety issues in an epilepsy monitoring unit (EMU). Several types of safety issues have been identified during monitoring: uncontrolled behavior (ictal and post-ictal aggression, self injurious behavior, psychosis); seizure related injuries (falls, status epilepticus); problems related to electrodes (pulling out scalp and surgically implanted electrodes); and specific concerns regarding children in the EMU. Use of restraints and sitters in selected patients, appropriate medication for psychosis, shock absorbing carpet and "child-proofing" rooms for the young are among the preventative actions discussed. Central to risk management is the education of the staff in the assessment of each patient's potential for injury and use the appropriate interventions. Consideration should be given to balancing the need to avert harm, with an unrestricted environment.
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PMID:Safety in long-term EEG/video monitoring. 895 Jun 95

The clinical significance of electroencephalographic (EEG) changes in patients with functional psychoses is not yet clearly defined, particularly whether these changes are state indicators or trait indicators. In the present review, the EEG abnormalities in schizophrenia are discussed. In early EEG studies of schizophrenics, the various specific EEG patterns were suggested to be trait indicators, but those findings were not confirmed. The EEG patterns of some patients with catatonic schizophrenia, especially periodic catatonia, were thought to be episode or state indicators, and some of the patients diagnosed as having atypical psychoses in Japan were suggested to show state indicator EEG findings. As the computerized and spectral analyses of EEG have advanced, the contradictory findings of EEG in schizophrenia have been reported, interpreted as 'hyperstable' or 'hypernormal' EEG findings and 'hypofrontal' EEG findings (slow waves in the frontal region). However, no conclusion can be made as to whether these EEG findings are state or trait indicators. On the borderland of functional psychoses, the behavioral changes in temporal lobe epilepsy were described as a trait indicator, and the psychotic states in non-convulsive generalized status epilepticus and acute confusional states were suggested to be state indicators. Further studies of EEG abnormalities in schizophrenia are necessary from multi-dimensional perspectives, including in comparison with the symptomatic psychoses.
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PMID:Electroencephalographic findings in functional psychoses: state or trait indicators? 976 84

Nonconvulsive status epilepticus (NCSE) is characterized by behavioral or cognitive change from baseline for at least 30 minutes with EEG evidence of seizures. Categorized into complex partial status epilepticus (with lateralized seizures), and generalized nonconvulsive status epilepticus (bilateral diffuse synchronous seizures), there is debate regarding the diagnosis and morbidity of NCSE. Because EEG is needed for diagnosis, only a high index of suspicion leads to a request for the study, whereas EEG is often unavailable after hours or on weekends. Furthermore, the cognitive changes during NCSE are often incorrectly ascribed to a postictal state, intoxication, psychogenic or psychotic states, and mental retardation. Regarding categorization, present classifications address EEG features but fail to distinguish among depths of coma. Deeply comatose patients (with coma etiologies that themselves carry poor prognoses) are mixed with lightly obtunded patients with no morbidity, confusing the prognosis. Thus, a classification that subsumes depth of coma, and possibly etiology, is sorely warranted. Regarding treatment, comatose NCSE patients treated with benzodiazepines may worsen, whereas generalized nonconvulsive status epilepticus patients may suffer iatrogenically from aggressive treatment (hypotension and respiratory depression) necessitating balancing the potential neurologic morbidity of NCSE against the possible morbidity of IV antiepileptic drugs. A high index of suspicion is needed to initiate EEG studies. Better stratification of level of consciousness will be needed to distinguish among morbidity due to underlying conditions, treatment, and the effects of status epilepticus, proper.
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PMID:Assessing the outcomes in patients with nonconvulsive status epilepticus: nonconvulsive status epilepticus is underdiagnosed, potentially overtreated, and confounded by comorbidity. 1047 7

A man aged 69 years with a history of a cerebrovascular accident showed progressively strange behaviour in two weeks. There were no signs of a neurological disorder. Psychiatric examination revealed psychotic symptoms. The electro encephalogram revealed epileptic activity at the site of the old infarct. The diagnosis was 'psychotic disorder due to a non-convulsive status epilepticus'. Treatment with anti-epileptics was followed by clinical recovery. An epileptic insult must be thought of in every elderly patient with unexplained changed behaviour. A cerebrovascular accident is the main risk factor for developing an insult in elderly.
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PMID:[Acute change in behavior of an elderly patient due to epilepsy]. 1049 18

The relationship of epilepsy with psychosis is intriguing to neurologists and psychiatrists alike. This review highlights these relationships, including (a) interictal psychosis, in which the presence of psychotic episodes is not temporally related to the occurrence of seizures, (b) postictal psychosis, characterized by an increased number of seizures followed by a period of lucidity and subsequent psychotic symptoms, and (c) ictal psychosis, in which psychotic symptoms occur in association with ictal discharges on EEG. Also discussed are other kinds of episodic symptoms that may mimic psychosis, including nonconvulsive status epilepticus, postictal delirium, and peri-ictal aggressive behavior. The controversial concept of "forced normalization," which proposes an antagonistic relationship between seizures and psychosis, is also explored. Finally, the potential contribution of antiepileptic drugs to psychotic symptomatology and the effects of antipsychotic agents on seizure threshold are examined.
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PMID:Psychosis and peri-ictal confusional states. 1049 32


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