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

A retrospective study was carried out on 261 patients with various epilepsies who had undergone convulsive status epilepticus prior to the subsequent onset of epileptic seizures. 1. Convulsive status epilepticus was found more in partial epilepsy and secondary generalized epilepsy at about the same rate, and evidently less in primary generalized epilepsy. On the average, three-fourths commenced their convulsive disorders with initial status epilepticus. 2. There were free intervals of years following initial status and preceding subsequent epilepsy. The interval was evidently shorter, less than two years, in a majority of patients with secondary generalized epilepsy, whereas the interval was mostly longer, more than six years, in patients with partial epilepsy. 3. The permanent deficient sequelae resulting from initial status were most closely associated with secondary generalized epilepsy. This was also exemplified by the higher rate of atrophic change on CCT. On the contrary, such permanent sequelae were less marked in partial epilepsy especially of complex seizure. 4. It was concluded that secondary generalized epilepsy resulted in cases with more severe brain damage within a relatively shorter interval, whereas complex partial seizure resulted from less severe damage with an obviously longer interval following convulsive status epilepticus.
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PMID:Status epilepticus in childhood: a retrospective study of initial convulsive status and subsequent epilepsies. 52 Sep 50

In 1979-80, 82 cases of grand mal status epilepticus (71 patients, 39 male and 32 female) were admitted to the Casualty Department of Meilahti University Hospital in Helsinki, Finland. The cause of the underlying epilepsy was symptomatic in 43 cases (52.4%) and idiopathic in 19 cases (23.2%). In 6 cases (7.3%), there was a history of alcohol withdrawal seizures, and in 14 cases (17.1%) there was no earlier history of convulsions. Status epilepticus was associated with an acute or progressive cerebral disorder in 14 episodes. These comprised 6 bouts of status with brain tumour, 4 with acute stroke and 4 with brain injury. Alcohol abuse preceded the status in 29 episodes (35.4%), 23 of which occurred in men (53.5% of the male cases). Excessive use of alcohol was the only obvious precipitating factor for status in 16 cases, and in 6 cases the status presented as a prolonged alcohol withdrawal seizure. A change or irregularity of anticonvulsive drug therapy could be documented in 14 cases and an acute infection outside the central nervous system in 7 cases. Intravenous diazepam, used as the only therapy for status epilepticus, was effective in 58 of 78 episodes. In 7 cases of prolonged status, a thiopental sodium anaesthesia proved effective. The total mortality was 4.2%, including 2 deaths from concomitant extracerebral disorders and one late death from brain metastasis.
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PMID:Status epilepticus and alcohol abuse: an analysis of 82 status epilepticus admissions. 651 94

Convulsive status epilepticus is an emergency that is associated with high morbidity and mortality. The outcome largely depends on etiology, but prompt and appropriate pharmacological therapy can reduce morbidity and mortality. Etiology varies in children and adults and reflects the distribution of disease in these age groups. Antiepileptic drug administration should be initiated whenever a seizure has lasted 10 minutes. Immediate concerns include supporting respiration, maintaining blood pressure, gaining intravenous access, and identifying and treating the underlying cause. Initial therapeutic and diagnostic measures are conducted simultaneously. The goal of therapy is rapid termination of clinical and electrical seizure activity; the longer a seizure continues, the greater the likelihood of an adverse outcome. Several drug protocols now in use will terminate status epilepticus. Common to all patients is the need for a clear plan, prompt administration of appropriate drugs in adequate doses, and attention to the possibility of apnea, hypoventilation, or other metabolic abnormalities.
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PMID:Treatment of convulsive status epilepticus. Recommendations of the Epilepsy Foundation of America's Working Group on Status Epilepticus. 813 76

We studied 80 hospitalized patients over 60 years old with either new-onset or newly diagnosed seizures that were generalized tonic-clonic in approximately half the cases and partial with or without secondary generalization in the other half. The etiology of seizures was acute symptomatic in 33 (41%), remote symptomatic in 32 (40%), progressive encephalopathy in nine (11%), and idiopathic in six (8%). Convulsive status epilepticus occurred in five cases (6%). The most common single cause of seizures was infarction or hemorrhage (54%). Morbidity and mortality were highest in the acute symptomatic group (p < 0.03). Nine (11%) of the subjects died within 3 months of admission, including two of the five with status epilepticus. Of the patients with acute symptomatic etiologies, 21% died compared with 6% of those in the remote symptomatic group. New neurologic deficits were present in eight (11%) of the 71 who survived, including five acute symptomatic, one remote symptomatic, and two progressive encephalopathy cases. No patient with idiopathic seizures died or had new neurologic deficits. We conclude that seizures in the elderly requiring hospitalization occur mainly with acute and remote symptomatic neurologic insults and are associated with a significant morbidity and mortality. In the absence of any associated neurologic insults, the morbidity is low.
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PMID:New-onset seizures in an elderly hospitalized population. 829 81

Convulsive status epilepticus (SE) is clinically defined as prolonged electrical and clinical seizure activity in which the patient does not regain consciousness to a normal alert state between repeated tonic-clonic attacks. The disorder is a neurological emergency associated with a mortality rate of 10-12% and an even greater morbidity. Seizures represent one of the most severe in vivo stimulatory stresses that the brain is exposed to and generalized status epilepticus represents a very severe form of seizures. The International Classification of Seizures has defined this condition as "a condition characterized by an epileptic seizure that is so frequent or so prolonged as to create a fixed and lasting condition". During SE, high-amplitude, high-frequency electrical activity lasting at least 5 min is seen in the EEG. Continuous seizure activity in itself will result in progressive brain injury. The longer the condition of SE, the more difficult it is to control and the more likely it is to result in permanent neuronal damage. Therefore, SE is an emergency situation requiring prompt medical attention if severe permanent brain damage or death is to be prevented. SE often occurs in individuals with a history of seizures, in whom there are neural substrates already predisposed towards supporting seizure activity.
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PMID:Lithium-pilocarpine neurotoxicity: a potential model of status epilepticus. 874 29

Convulsive status epilepticus (SE) is convincingly related to serious morbidity and mortality and well recognized as a medical emergency, but prompt diagnosis and treatment of patients with nonconvulsive status epilepticus (NCSE) is often not emphasized because its consequences are thought to be benign. Nonconvulsive status epilepticus has been considered a relatively benign entity because it does not produce the adverse systemic consequences of convulsive status epilepticus, such as hyperthermia, acidosis, hyperkalemia, pulmonary compromise, or cardiovascular collapse. However, recent reports indicate that NCSE is not so benign. There are two major forms of NCSE, absence status epilepticus and complex partial status epilepticus. Typical absence status epilepticus does not appear to have very serious consequences and may be a type of "inhibitory" seizure, but complex partial status epilepticus has been associated with serious morbidity and mortality. Despite not causing the systemic physiologic or metabolic derangements seen with convulsive SE, complex partial status epilepticus is still associated with the two other major factors correlated with poor outcomes in convulsive SE: 1) neuronal damage from abnormal electrical activity and 2) the interaction of acute neurologic disorders, such as stroke, that may precipitate SE. Other similar epileptiform encephalopathies such as "subclinical," "electroencephalographic," "nontonic-clonic," and "subtle" SE have not been as well studied as NCSE but pose similar issues. Early diagnosis and aggressive intervention have proven the best means of averting adverse outcomes in patients with convulsive SE. The diagnosis and treatment of NCSE, particularly complex partial status epilepticus, merit similar emphasis and attention.
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PMID:Epidemiology and evidence for morbidity of nonconvulsive status epilepticus. 1047 4

Convulsive status epilepticus is a major epileptic emergency. Prompt and effective treatment is requested to prevent death or neurological sequel. First-line drugs must have a favourable benefit to risk ratio. Refractory status must be treated aggressively by second-line sedative drugs. In this situation, EEG monitoring must diagnose subtle status epilepticus by controlling the disappearance of ictal discharges. Non-convulsive generalized or partial status epilepticus is a diagnostic challenge, best solved by emergency EEG. Immediate discontinuation of antiepileptic drugs is requested to avoid potentially serious idiosyncratic side-effects. Prescriptions habits will be avoided to prevent recurrence of isolated convulsive seizures.
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PMID:[Epileptic emergencies]. 1119 70

Our aim was to study the frequency and reasons an emergent electroencephalogram (EmEEG) is ordered in the ICUs compared to the hospital ward, examine its usefulness and find predictive variables for its results. We retrospectively identified all electroencephalograms ordered between December 1997 and March 2002 and performed within 1 hour. The tests ordered from four ICUs were compared with those ordered from the Ward beds, and predictive models were developed for the results based on clinical variables. We also compared the EmEEGs ordered by the Neuro-ICU to those from the other Units. The ICUs ordered 129 (49.4%) of all EmEEGs during the study period. The NICU ordered 32 tests. The most frequent reason for obtaining the test was to rule out status epilepticus (68.2%). The NICU ordered more frequently the test to exclude non-convulsive status than the other ICUs. Compared to non-ICU, ICU patients with head trauma or post cardiopulmonary arrest had more tests and patients with stroke fewer. Convulsive status epilepticus and generalized slowing were found more frequently in the ICUs, and normal EEG, interictal epileptiform activity or focal non-epileptic slowing were more frequent in the non-ICU cases. In at least 12.4% of ICU patients, the test was expected to lead to an anti-epileptic management change. Cardiopulmonary arrest and age were predictive of any epileptic activity on the EEG in ICU patients. In conclusion, in our institution EmEEG is ordered by the ICUs in two thirds of the cases to exclude status epilepticus. Although status epilepticus is confirmed more frequently in the ICUs than on the Ward, the most frequent finding remains generalized slowing, which is found in half of the ICU-ordered EmEEGs. A conservative estimation is that EmEEG will lead to medication change in at least 1 out of 8 ICU patients. Cardioopulmonary arrest is predictive of epileptic activity and a prolonged EmEEG may also increase the yield.
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PMID:Emergent electroencephalogram in the intensive care unit: indications and diagnostic yield. 1549 31

Convulsive status epilepticus is associated with subsequent hippocampal damage and development of mesial temporal sclerosis in a subset of individuals. The lithium pilocarpine model of status epilepticus (SE) in the rat provides a model in which to investigate the molecular and pathogenic process leading to hippocampal damage. In this study, a 2-DE-based approach was used to detect proteome changes in the hippocampus, at an early stage (2 days) after SE, when increased T2 values were detectable by magnetic resonance imaging. Gel image analysis was followed by LC-MS/MS identification of protein species that differed in abundance between pilocarpine-treated and control rats. The most significantly up-regulated species in the experimental animals was identified as heat shock 27-kDa protein, in line with findings in humans and in other experimental models of epilepsy. Additional up-regulated species included dihydropyrimidinase-related protein-2, cytoskeletal proteins (alpha-tubulin and ezrin) and dihydropteridine reductase. In summary, the hippocampus of rats subject to pilocarpine-induced SE exhibits specific changes in protein abundance, which likely relate to pathogenic, neuroprotective and neurogenic responses.
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PMID:Proteome changes associated with hippocampal MRI abnormalities in the lithium pilocarpine-induced model of convulsive status epilepticus. 1736 78

Convulsive status epilepticus is a relatively common life-threatening illness requiring prompt intervention. There has been much debate about the appropriate protocol for management of convulsive status epilepticus. Published data on the management of this condition in Ireland is limited. Our aim was to establish if there was a structured, evidence-based or consensus-based protocol being implemented in the management of status epilepticus in our centre. We retrospectively audited all charts with a diagnosis of 'Status Epilepticus' admitted to our hospital from January 1998 to December 2002. A total of 95 episodes of convulsive status epilepticus were recorded. 34 charts were reviewed. Benzodiazepines were the drug class of first choice in 96% of patients. However, the doses of benzodiazepines used varied widely. The most frequent dose of phenytoin used was 1 gram. No one received continuous EEG monitoring during treatment of refractory status epilepticus. Overall mortality was 18%. The results of this study show that there is no consistent protocol was being followed for the management of convulsive status epilepticus in our centre. The drugs of first choice varied between diazepam and lorazepam in most cases. Although phenytoin was used as second line drug, the dose used was frequently suboptimal. We have developed a protocol for the management for convulsive status in our centre.
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PMID:New lessons: Classic treatments in convulsive status epilepticus. 1845 Feb 54


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