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

Generalized tonic-clonic status epilepticus is usually treated with intravenous benzodiazepines and phenytoin. Patients who do not respond to this treatment are generally treated with phenobarbital or general anesthetics both of which may require intubation to maintain respiration. Our experience of four cases with status epilepticus treated with intravenous lidocaine who had failed to respond to diazepam and phenytoin therapy is presented. Two cases responded to a single dose of lidocaine, one required a second dose of lidocaine to control seizures, and the fourth patient failed to respond and died as a result of associated severe head injury. Therefore, there is a need to conduct further studies to establish the efficacy of intravenous lidocaine in the treatment of refractory status epilepticus.
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PMID:Lidocaine in refractory status epilepticus: a forgotten drug in the emergency department. 848 68

We retrospectively reviewed the clinical course of 66 patients treated for generalized tonic-clonic status epilepticus at the Ege University neurological intensive care unit from 1988 to 1997. Seventy-two per cent of the study group had a pre-existing seizure disorder, and antiepileptic drug withdrawal was the most prominent cause of status epilepticus. The other causes included drug toxicity, central nervous system infection, cerebrovascular disease, tumour and trauma. Seventy-three per cent of all patients responded to the first-line therapy (diazepam and/or phenytoin), and the remainder were considered to have refractory status epilepticus and required pentobarbital anaesthesia. Overall case fatality was 21%, but death could be attributed directly to status epilepticus and/or treatment complication in 10% of the study group. Major determinants of fatal outcomes were: increasing age, longer duration of status epilepticus before initiation of therapy and central nervous system infection as a causal factor.
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PMID:Generalized tonic-clonic status epilepticus: causes, treatment, complications and predictors of case fatality. 977 62

This chapter reviews two main aspects of the basic mechanisms of status epilepticus--acute factors, which are important in inducing status epilepticus in an in vitro brain slice model of status epilepticus, and the acute and chronic epileptogenic consequences of status epilepticus. Status epilepticus is difficult to produce in vitro in normal extracellular medium. This suggests that seizure-terminating mechanisms are normally quite robust. To produce long- duration, self-sustained epileptic discharges in vitro, we have found it necessary to include reciprocally connected entorhinal cortex with our hippocampal slices. Doing so closes the normal excitatory limbic loop in the brain. We found incorporation of the full loop in our brain-slice preparations necessary to bring about epileptic discharges of long duration that fit the definition of status epilepticus. Reentrant activation from distant sites may be necessary for maintenance of status epilepticus-like activity of long duration. Similar requirements may exist for generalized tonic-clonic status epilepticus discharges, but as yet no data support or refute this hypothesis. There are both acute and chronic consequences of an episode of status epilepticus. Acute consequences are alterations in membrane potential and membrane properties of hippocampal pyramidal cells accompanied by alterations in neurotransmitter-activated conductances and receptor expression. Some of these acute alterations in receptor and transmembrane iongradient associated with status epilepticus may be critically involved in the development of drug resistance during the late stages of status epilepticus. Long-term consequences of status epilepticus in the limbic system include alterations in patterns of expression of neurotransmitter receptors and in the function of excitatory and inhibitory synapses, cell loss, and circuit rearrangements within the limbic system. An episode of status epilepticus that involves the limbic system clearly elicits brain damage, at least among adult animals. This brain damage can contribute to the development of epilepsy, or a condition of recurrent, spontaneous seizures. Conversely, development of an epileptic condition enhances the susceptibility of the limbic system to trigger status epilepticus discharges.
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PMID:Basic mechanisms of status epilepticus. 1051 58

Neuronal damage has been observed in the medial temporal lobe of both humans and animals following status epilepticus. The aim of the present study was to investigate the occurrence of medial temporal lobe damage in status epilepticus patients treated in hospital with a predetermined protocol and to assess whether the changes progress in a long-term follow-up. The volumes of the hippocampus, amygdala, entorhinal and perirhinal cortices were measured using magnetic resonance imaging (MRI) in nine adult patients with status epilepticus 3 weeks, 6 and 12 months after the insult. The control group included 20 healthy subjects. The etiology of status epilepticus was an acute process in one patient and a chronic process in eight cases. The mean duration of secondarily generalized tonic-clonic status epilepticus episodes was 1 h and 44 min. Volumetric MRI indicated that none of the patients developed marked volume reduction in the hippocampus, amygdala, or the entorhinal and perirhinal cortices during the 1-year follow-up period. Status epilepticus does not invariably lead to a progressive volume reduction in the medial temporal lobe structures of adult patients treated promptly in hospital with a predetermined protocol for rapid cessation of seizure activity.
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PMID:MRI volumetry of the hippocampus, amygdala, entorhinal cortex, and perirhinal cortex after status epilepticus. 1086 43

Status epilepticus is a medical emergency, if not treated in time and effectively may cause significant mortality and morbidity. Medical therapy has been the mainstay of treatment but in refractory status surgical resection, multiple subpial transection, electroconvulsive therapy, caudate stimulation and acupuncture play important role. The present operational definition for adults and older children considers status as > or = 5 minutes of continuous seizure or two or more discrete seizures without regaining of full consciousness. Status epilepticus accounts for 1-8% of all hospital admissions for epilepsy. Physiological changes in generalised convulsive status epilepticus include transient or early (0-30 minutes) and late (after 30 minutes) changes. Temporal changes occur as tonic-clonic status epilepticus progresses. Management can be considered in two ways--out hospital management and inpatient management. Benzodiazepine is considered 1st line of treatment outside hospital. Emergency/inpatient management includes basic life support (0-10 minutes) and pharmacological management (10-60 minutes). Drugs used in pharmacological management are lorazepam, midazolam, propofol, phenobarbital, phenytoin, fosphenytoin, i.v. valproate, rectal diazepam, etc. The classical definition of refractory status epilepticus includes seizure that has not responded to sequential treatment of lorazepam, phenytoin or phenobarbitone or seizure continuing > 60-90 in spite of adequate treatment.
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PMID:Management of status epilepticus. 1241 29

We describe a patient who entered a stuporous state after receiving benzodiazepine treatment for generalized tonic-clonic status epilepticus. A diagnosis of generalized NCSE with tonic seizures was made on the basis of the clinical picture and response to barbiturate anaesthetic, although the EEG pattern was not typical of the changes previously described in tonic seizures-tonic status epilepticus. This report discusses the differential diagnosis of postictal stupor, nonconvulsive status epilepticus with tonic seizures and sedation caused by the emergency treatment of status epilepticus, and summarizes the literature on tonic seizures and tonic status epilepticus.
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PMID:Prolonged postictal stupor: nonconvulsive status epilepticus, medication effect, or postictal state? 1619 25

Seizure emergencies are potentially life-threatening events that are under-recognized. Status epilepticus is associated with considerable rates of morbidity and mortality. Experts currently believe that any episode of seizure activity lasting 5 minutes or longer should be considered status epilepticus. Treatment should be initiated as early as possible; evidence has shown that once seizures persist for 5 to 10 minutes, they are unlikely to stop on their own in the subsequent few minutes. Prehospital treatment with benzodiazepines has been shown to reduce seizure activity significantly compared with seizures that remain untreated until the patient reaches the emergency department. The consequences of delayed treatment of status epilepticus include a serious risk of subsequent prolonged seizure activity or epileptogenesis, memory deficits, and learning difficulties. The importance of timely intervention in generalized tonic-clonic status epilepticus must be emphasized. Recent research has found that emergency department personnel fail to recognize the condition in children in 34% of cases.
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PMID:Overview: definitions and classifications of seizure emergencies. 1769 82

The annual incidence of status epilepticus based on the definitions of the International League Against Epilepsy (1993) ranges from 10.3 to 41 per 100,000 inhabitant. Half of the cases of status epilepticus concern epileptic patients. In all studies, incidence is higher in epileptic patients, young children and the elderly. It is estimated that 13% of patients with status epilepticus will experience recurrence during the two first years. The three leading etiologies are low-dose antiepileptic drugs, non-acute brain lesions and acute stroke. Seizures are generalized in 9 to 33% of patients and focal in 25 to 75%. Secondary generalized seizures can be observed in 19 to 66% of patients. Mortality ranges from 7.6 to 39% and varies as a function of inclusion of postanoxic encephalopathies and difference in initial care. The definition retained and the classification adopted for status epilepticus also affect mortality estimates. Status epilepticus is defined as the existence of a prolonged seizure or a series of seizures during which the patient does not recover, or incompletely recovers, consciousness. The duration parameter used to distinguish status epilepticus from a seizure remains controversial. At the present time, there is general agreement in the literature distinguishing two definitions based on different durations according to the clinical type of status epilepticus and its potential severity: (i) a status epilepticus is defined by a seizure lasting more than 30 minutes or recurrent seizures without recovery of consciousness over a period of 30 minutes; (ii) considering its severity, tonic-clonic status epilepticus has a specific definition leading to earlier therapeutic management. This operational definition is continuous, generalized, convulsive seizure lasting more than five minutes or two or more seizures during which the patient does not return to baseline consciousness. Several types of background can be used to establish a classification for status epilepticus: clinical manifestations, prognostic and therapeutic course, epidemiological data, pathophysiological mechanisms... At the present time, the classifications most commonly used in France for status epilepticus are derived from the syndromic epileptic classification, the seizure classification or the classification proposed by the French consensus workshop on status epilepticus. For routine clinical practice, an operational classification can be used to adopt therapeutic strategies adapted to probable prognosis: short-term life-threatening, mid-term life-threatening, not life-threatening.
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PMID:[Satus epilepticus: epidemiology, definitions and classifications]. 1921 Nov 16

Increasing duration of generalized tonic-clonic status epilepticus increases the risk of neuronal damage and systemic complications. It is also a recognized contributing factor to drug resistance. The most indispensable quality an anticonvulsive medication is expected to have in this situation is therefore a rapid therapeutic effect, achieved without severe depressive, neurological, cardiovascular or respiratory side effects. The anticonvulsive strategy proposed here takes into account these prerequisites, as well as previously published research findings which remain limited on a number of aspects. The duration of the convulsions before medication must be taken into account when deciding on the initial treatment. If this is less than 30 min, a single drug regimen with benzodiazepine would be appropriate and sufficient initially. If lorazepam, which is unavailable in France, cannot be used, the pharmacokinetically similar clonazepam should be preferred. Beyond 30 min, a combination of benzodiazepine and an anticonvulsive with long-lasting effects -phenobarbital or fosphenytoin- is indicated. The choice between these two latter drugs depends on their respective contraindications and the circumstances surrounding the occurrence of the status epilepticus. The persistence of seizures beyond 20 min after beginning the phenobarbital infusion or 30 min after starting fosphenytoin signals a failure of the initial treatment and requires the immediate introduction of a second line of therapy. This may be an anticonvulsive with long-lasting effects providing the convulsions have been present for less than an hour, there is no suspicion of an acute cerebral lesion and there is no associated systemic factor of cerebral aggression. If not, the employment of anesthetic medication is immediately required.
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PMID:[Management of convulsive status epilepticus: therapeutic strategies]. 1927 2

Nonconvulsive status epilepticus (NCSE) refers to a prolonged seizure that manifests primarily as altered mental status as opposed to the dramatic convulsions seen in generalized tonic-clonic status epilepticus. There are 2 main types of NCSE, each of which has a different presentation, cause, and expected outcome. In the first type of NCSE, patients present with confusion or abnormal behavior, suggesting the diagnosis of absence status epilepticus (ASE) or complex partial status epilepticus (CPSE). The second type of NCSE (subtle status epilepticus [SSE]) must be considered in comatose patients who present after a prolonged generalized tonic-clonic seizure and who may have only subtle motor manifestations of a seizure, such as facial or hand twitchings. Whereas the morbidity and mortality in patients with prolonged ASE or CPSE is low, the mortality associated with SSE can exceed 30% if the seizure duration is greater than 60 minutes.
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PMID:Nonconvulsive status epilepticus. 2110 3


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