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)

A 40-year-old conductor was admitted because of increasing drowsiness and confusion. Two years before admission he had had a first seizure. One year before admission he had a generalized convulsive status epilepticus; the following months he was less able to concentrate. A second status epilepticus was followed by transient weakness of his left arm and a depressed level of consciousness for several weeks. After awakening, he had delusions, and his wife found him demented. In the following months his confusion and drowsiness gradually deteriorated. He had previously had gonorrhoea, an episode of fever and exanthema, and was found to have oligospermia as cause of his infertility. On examination he was disoriented, and he had dysarthria. His left pupil was smaller, but both pupils reacted normally. There was left hemianopia and cerebellar ataxia. CT and MR showed large ventricles and periventricular diffuse lesions in the white matter. CSF examination revealed leucocytosis and increased protein content. Further examination were focussed on serological evidence of syphilis, and finally neurosyphilis was diagnosed. After treatment with penicillin, the patient started to recover.
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PMID:[Clinical judgment and decision making in clinical practice. A music conductor with epilepsy followed by memory disorders]. 921 89

We report on a 27-year-old woman of non-convulsive status epilepticus (NSE) very probably induced by antidepressants. She has no history of febrile convulsions, or epileptic seizures. There are no genetic factors for epilepsy in her family. As she developed depressive illness, she consulted a doctor. Clomipramine 25 mg i.v. drip/day and maprotiline 75 mg/os/day were started. Recently she began to doze, so an EEG was performed. Continuous generalized 2-3 Hz spike and wave complexes were observed. Clomipramine and maprotiline were stopped the same day, and the patient's drowsiness gradually improved. There are some case reports of NSE induced by antidepressants. However, the patients in these reports had received frequent electroconvulsive therapy (ECT) and were middle aged and may have been affected by an organic brain disorder. The present patient was young, and had not received ECT. It is therefore very likely that antidepressants may have been responsible for the occurrence of NSE in this patient. It is concluded that NSE should be considered an adverse effect of any antidepressant.
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PMID:Non-convulsive status epilepticus induced by antidepressants. 966 5

Status Epilepticus (SE) is a medical emergency warranting prompt treatment with rapidly-acting antiepileptic drugs. For immediate effect, benzodiazepines are the drugs of choice, but may result in morbidity due to respiratory suppression and hypotension. Nonconvulsive status epilepticus usually does not have significant neurological sequelae, and there is little evidence that generalized nonconvulsive status epilepticus (GNSE) causes lasting neurologic deficits. The risk versus benefit of potentially morbid medications must, therefore, be weighed against the "adverse effects" of GNSE. A patient with frequent episodes of GNSE lasting 4-48 hours had previously been treated with benzodiazepines, but required admission for consequent somnolence. Following intravenous valproate given during EEG monitoring, GNSE broke after 30 minutes. The confused patient returned to a normal cognition and returned home without sequelae. Intravenous valproate may provide an effective treatment alternative to benzodiazepines in GNSE without their associated morbidity.
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PMID:Intravenous valproate treatment of generalized nonconvulsive status epilepticus. 989 Nov 83

Tiagabine, a specific gamma-aminobutyric acid-uptake inhibitor, has been shown to be reasonably well tolerated and efficacious as adjunctive treatment for partial seizures in adults and is now being investigated in children. This 4-month, single-blind study evaluated the tolerability, safety and preliminary efficacy of ascending doses (0.25-1.5 mg/kg/day) of tiagabine add-on therapy in 52 children over the age of 2 years with different syndromes of refractory epilepsy. Adverse events, mostly mild to moderate, were reported by 39% of children during the single-blind placebo period and by 83% of children during tiagabine treatment. The events predominantly affected the nervous system with asthenia (19%), nervousness (19%), dizziness (17%) and somnolence (17%) being the most common. Only three children (6%) withdrew because of adverse events. Tiagabine appeared to reduce seizures more in localisation-related epilepsy syndromes than in generalised epilepsy syndromes. Twenty-three patients with localisation-related epilepsy syndromes were included and 17 of these patients entered the fourth dosing period. The 17 patients had a median reduction of seizure rate in the fourth month of treatment of 33% compared with baseline. In comparison, 13 of 22 children with seven different generalised epilepsy syndromes entered the fourth dosing period with a median change of seizure rate of 0%. Two patients experienced single episodes of status epilepticus during treatment; both cases resolved. Tiagabine showed efficacy mainly in localisation-related syndromes and was well tolerated by most children in a group of very refractory patients and warrants further study in children with epilepsy.
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PMID:Tiagabine adjunctive therapy in children with refractory epilepsy: a single-blind dose escalating study. 1107 88

The aim of this prospective, uncontrolled clinical study was to evaluate the tolerability and the efficacy of levetiracetam as add-on treatment in 78 adults and 44 children with intractable epilepsy. The patients' seizure frequency in the 8 weeks baseline period was compared to their seizure frequency after a mean follow-up of 8 months of treatment.A greater than 50% reduction in seizure frequency was achieved in 31 adults (40%) and 9 children (20%), of whom 7 adults (9%) and 3 children (7%) became seizure free. Most often levetiracetam was well tolerated, somnolence being the most frequently reported side effect (18% in adults and 7% in children). However, in 14 adults (18%) and 19 children (43%) levetiracetam was associated with an increase (>25%) in seizure frequency. Such a paradoxical effect, including the development of status epilepticus in three adults and four children, appeared most often in mentally retarded patients during the first 2 months of treatment, and on relatively high doses. Two children developed status epilepticus after 5 and 7 months, respectively. In conclusion, levetiracetam is usually well tolerated as add-on treatment in patients with difficult-to-treat partial onset seizures. By using a lower initial dose and a slower dose escalation than recommended by the manufacturer, a paradoxical effect may perhaps be avoided. In children, doses >20 mgkg(-1) per day should be introduced with caution.
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PMID:A paradoxical effect of levetiracetam may be seen in both children and adults with refractory epilepsy. 1249 48

Three patients with severe motor and intellectual disabilities presented deterioration of the activities of daily living, which was revealed to be caused by prolonged non-convulsive status epilepticus (NCSE). Their condition improved by the treatment with antiepileptics. Case 1, a 4-year-old girl with profound psychomotor retardation and past history of West syndrome of unknown etiology, became unable to sit and eat orally above age of two years. EEG showed continuous generalized slow spike and wave bursts indicating NCSE. Continuous intravenous infusion of midazolam abolished EEG abnormalities of NCSE, and she regained the ability of oral feeding. Case 2, a 3-year-old boy with Angelman syndrome and past history of West syndrome, presented decreased mental response, poor oral intake and somnolence. EEG showed continuous slow spike and wave bursts, indicating NCSE. High-dose phenobarbital therapy and continuous intravenous injection of vitamin B6 were effective, and remarkably improved his psychomotor activities. Case 3, a 3-year-old boy with Lennox-Gastaut syndrome, developed decreased psychomotor activity and loss of vocalization and walking. He could not sit by himself and became nearly bed-ridden. EEG showed very frequent generalized spike and wave bursts, showing NCSE. Continuous infusion of thiopental diminished NCSE, and he could walk again. Psychomotor deterioration in patients with severe motor and intellectual disabilities may be caused by NCSE, which should not be overlooked.
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PMID:[Three cases with severe motor and intellectual disabilities presenting the severest condition caused by prolonged non-convulsive status epilepticus]. 1260 90

A few publications documented the coexistence of epilepsy and obstructive sleep apnea (OSA). The extent, nature, and clinical relevance of this association remain poorly understood. We retrospectively reviewed the database of our sleep center to identify patients with both sleep apnea and epilepsy. Characteristics of epilepsy, sleep history, presence of excessive daytime sleepiness [Epworth Sleepiness Scale (ESS)] and polysomnographic data were assessed. The effect of continuous positive airway pressure (CPAP) on seizure reduction was prospectively analyzed after a median interval of 26 months (range: 2-116 months) from the diagnosis of OSA. OSA was found in 29 epilepsy patients (25 men and 4 women) with a median age of 56 years (range: 37-79). The median apnea hypopnea index was 33 (range: 10-85), the oxygen desaturation index was 12 (range 0-92), and 52% of the patients had an ESS score >10. In 27 patients, epilepsy appeared 1 month to 44 years prior to the diagnosis of OSA. In 21 patients, the appearance of OSA symptoms coincided with a clear increase in seizure frequency or the first appearance of a status epilepticus. Treatment with CPAP was continued with good compliance in 12 patients and led to a significant reduction of both ESS scores and seizure frequency in 4 patients. Our data suggest the importance of considering diagnosis and treatment of OSA in epilepsy patients with poor seizure control and/or reappearance of seizures after a seizure-free interval.
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PMID:Epilepsy and obstructive sleep apnea. 1656 44

A 64 year old female patient with previously known temporal lobe epilepsy (TLE) was admitted to the emergency department (ED) for further investigation of somnolence of unknown origin. Differential diagnosis remained puzzling after exclusion of an intracranial process and status epilepticus. Quantitative and qualitative fluctuations of consciousness are well known to take place in TLE as well as that these patients often are receiving several drugs for their illness. Drug history and measuring serum drug levels are helpful. Adverse Drug Events (ADE) are not rare in EDs: approximately 5% of ED patients are suffering an ADE and about 3% of patients admitted to hospitals are admitted because of an ADE. It is important to realize that three out of four ADEs are estimated to be preventable.
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PMID:[Somnolence of unknown origin--illness or drug problem?]. 1713 99

Two patients, a 35-year-old woman and a 60-year-old man, developed severe neurological side effects during treatment with phenytoin: disorientation, myoclonia, hallucinations and drowsiness in the first patient and a comatose state in the second. The woman had spina bifida, a ventriculoperitoneal drain because of hydrocephalus, recurrent urinary-tract infection, and a history of status epilepticus. The man suffered from diabetic ketoacidosis complicated by epileptic convulsions. In both patients, the total phenytoin concentration in the blood was within the therapeutic range of 8-20 mg/l. However, both had low serum albumin concentrations, below 25 g/l. Low serum albumin levels are associated with increased concentrations of the free fraction of phenytoin. Toxic levels of free phenytoin were found: 4 and 8 mg/l, respectively, while the therapeutic range is 0.5-2 mg/l. The first patient recovered after treatment with phenytoin was stopped, after which she was placed on a lower dosage; the second patient died. When prescribing phenytoin to patients with hypoalbuminaemia, one should be aware of the risk of intoxication due to a high level of free phenytoin and consequently an increased risk of severe neurological side effects.
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PMID:[Severe phenytoin intoxication in patients with hypoalbuminaemia]. 1752 Aug 54

Carisbamate is a novel drug with neuromodulator activity that is currently under development for the treatment of epilepsy, diabetic neuropathy and neuralgia. The compound possessed a promising pharmacological profile in tests in vivo, and demonstrated broad anticonvulsant activity in preclinical studies, both elevating seizure threshold and preventing seizure spread. Carisbamate was also effective in protecting against spontaneous recurrent seizures in kainate-treated animals and in genetic models of epilepsy, and displayed antiepileptic and neuroprotective activity in the lithium-pilocarpine model of status epilepticus. In a phase I clinical trial, orally administered carisbamate demonstrated efficacy at high doses of 500 to 1000 mg. A phase II clinical trial confirmed that oral carisbamate was efficacious at a 300- to 1600-mg dose range. The preliminary evaluations of carisbamate in humans indicated complete absorption, extensive metabolism, and carbamate ester hydrolysis. The most frequently reported side effects associated with carisbamate are dizziness, headache, somnolence and nausea. In clinical trials, carisbamate did not display any significant interactions with commonly used antiepileptic drugs such as carbamazepine, valproate and lamotrigine. At the time of publication, a phase III clinical trial for carisbamate in the treatment of epilepsy was ongoing, as well as phase II trials in neuropathy and neuralgia. Data from preclinical brain injury studies with carisbamate and the analog RWJ-333369-A have also been reported. This drug profile will focus on the development of carisbamate in epilepsy.
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PMID:Carisbamate, a new carbamate for the treatment of epilepsy. 1789 91


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