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

Two patients with status epilepticus who were resistant to conventional treatment but responded to propofol infusions are reported. An electroencephalogram confirmed the seizures and their successful treatment.
Anaesthesia 1990 Dec
PMID:Propofol infusion for control of status epilepticus. 227 26

Status epilepticus is a neurological emergency and refractory one often resulted in neurological damage or death. Since the basic mechanisms of status epilepticus was not fully understood, a surgical treatment was not attempted until now. In the present study, a surgical resection of the epileptic focus was made in experimentally induced limbic status epilepticus and influences of the surgery upon status epilepticus was discussed. Limbic status epilepticus was induced by means of kainic acid (KA) microinjection into unilateral amygdala in cats and effects of focus resection upon limbic seizure status were studied. Ten adult cats were stereotaxically operated on under pentobarbital anesthesia. Bipolar electrodes were placed in bilateral amygdala and hippocampus. An injection cannula, designed for kainic acid injection, was placed in the left amygdala. The cats were then divided into two groups. Group A (5 cats) received 0.5 microgram of KA injection into the amygdala resulted in mild limbic status. Two of them were controls and 3 of them received amygdalotomy after induction of the limbic seizure status. Group B (5 cats) received 2.0 micrograms KA injection resulted in severe limbic status. Moreover, independent spontaneous seizure activities were observed in the ipsilateral hippocampus. Two of them were controls and 3 of them were operated on. After amygdalotomy, limbic seizure stopped in the operated cats of Group A. In the operated cats of Group B, repeated seizures in the epileptogenic focus (amygdala) was completely suppressed, however, spontaneous seizures of the ipsilateral hippocampus persisted even after the surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Experimental limbic seizure status epilepticus and focus resection in cats]. 262 42

We report the results of treatment of refractory generalized tonic-clonic status epilepticus in 17 adults. Of 13 patients who received high-dose phenytoin (PHT, mean dose 23.8 mg/kg), seizure control was sustained in five patients. In 12 cases, anesthetic doses of pentobarbital rapidly suppressed convulsions, but sustained control required prolonged treatment. Break-through seizures were, in most cases, explained by inadequate serum pentobarbital concentrations, although we could not establish a therapeutic range of serum concentrations. EEG monitoring is necessary to assess the therapeutic response but is not a reliable index of depth of anesthesia. Some cases developed pharmacodynamic tolerance to pentobarbital. The most serious treatment complications were cardiorespiratory, but the most common and disabling side effects, although reversible, were neurologic. Fifteen patients were discharged from the hospital in stable condition; two patients died, but not as a direct consequence of treatment. Our results suggest a very good outcome of pentobarbital anesthesia for patients in refractory status epilepticus who are a reasonable medical risk and who receive optimal medical management.
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PMID:Treatment of refractory generalized tonic-clonic status epilepticus with pentobarbital anesthesia after high-dose phenytoin. 275 97

When conventional therapy fails in status epilepticus, general anesthesia is recommended. We present our experience with isoflurane, an inhalational anesthetic, in the management of a patient with refractory status epilepticus. The seizures were controlled with relatively small concentrations of isoflurane. Hypotension, the only adverse effect of isoflurane, was managed with fluid and dopamine infusions.
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PMID:Isoflurane for the management of status epilepticus. 276 80

Thiopentone anaesthesia was used in the treatment of seizures in 19 infants and young children. Nine had a pre-existing seizure disorder without acute cerebral injury and 10 had status epilepticus secondary to an acute cerebral illness. Clinical details, drug levels and findings from serial multichannel electroencephalograms (EEG) and continuous 1 to 2 channel signal processed EEGs using a Cerebral Function Analysing Monitor (CFAM) were reviewed to evaluate the contribution of these techniques to clinical management. Initial EEGs showed discharges that were not generalised in 16/19 patients. This necessitated the use of 7 different montages for continuous monitoring. Three different CFAM patterns representing particular EEG paroxysmal findings were seen. Acute seizure control was achieved in all 19 patients. All patients with a pre-existing seizure disorder survived, although 4/10 with an acute cerebral illness died. During treatment, patterns of burst-suppression to electrocerebral silence (ECS) were eventually seen in 16/19 patients and repeat EEGs demonstrated concordant multi-channel findings in 8/8. Although increasing thiopentone levels (13 patients) correlated with deeper suppression of cortical electrical activity, there was marked inter-patient variability. Inotropic support was not required during the period of treatment even when ECS was induced. In young children a combination of multi-channel EEG and continuous 1 to 2 channel monitoring has advantages over either method used alone. In individual patients on-line monitoring can be easily incorporated in a protocol of controlled cortical suppression and drug titration for seizure control.
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PMID:EEG monitoring of prolonged thiopentone administration for intractable seizures and status epilepticus in infants and young children. 277 43

General anesthesia has been recommended to control convulsive status epilepticus that is refractory to conventional anticonvulsant therapy. Halothane has been the recommended agent, but without experimental justification. Isoflurane, which has no reported organ toxicity and produces electrographic suppression at clinically useful concentrations in normal humans, should be a better volatile anesthetic for this purpose. The efficacy and safety of isoflurane administered to control convulsive status epilepticus were assessed on 11 occasions in nine patients in seven North American hospitals. Isoflurane, administered for 1-55 h, stopped seizures in all patients and was able to be titrated to produce burst-suppression patterns on electroencephalograms. Blood pressure support with iv fluids and/or pressor infusions was required in all of the patients. Seizures resumed upon discontinuation of isoflurane on eight of 11 occasions. Six of the nine patients died. The three survivors sustained cognitive deficits. In one patient urine fluoride concentrations were elevated, although not to nephrotoxic levels. These cases suggest that isoflurane 1) is an effective, rapidly titratable anticonvulsant; 2) does not reverse underlying causes of the refractory seizures; and 3) usually necessitates hemodynamic support with fluids and/or pressors. Isoflurane may be administered for seizures, but only when iv agents in anesthetic doses are ineffective or produce unacceptable side effects.
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PMID:Isoflurane for refractory status epilepticus: a clinical series. 281 58

Status epilepticus (SE) is defined as a continuous seizure that lasts more than 30 minutes or as serial seizures in which the patient does not regain a premorbid level of consciousness. This condition exists primarily in two forms: convulsive (focal or generalized) and nonconvulsive (absence or partial complex) SE. Protracted or serial convulsive seizures represent a medical emergency with a current mortality rate of 10%. As in any urgent or life-threatening situation, the initial treatment is directed at support and maintenance of vital functions. Specific anticonvulsant management is usually begun with intravenous lorazepam. This benzodiazepine is replacing diazepam in many medical centers because it has a longer duration of action and causes less respiratory depression. Concurrent intravenous loading with phenytoin is usually necessary for sustained control of seizures. Phenobarbital may be required as a third drug if seizures persist or recur. In cases of refractory status epilepticus, barbiturate coma, continuous anticonvulsant intravenous infusion, or general anesthesia may be necessary.
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PMID:Status epilepticus in children and adults. 305 85

We report our experience using barbiturate anesthesia for the treatment of refractory status epilepticus. Following a retrospective review of eight patients treated with a variety of barbiturates and dosing regimens, we established a specific protocol employing pentobarbital and evaluated it prospectively in six patients. Among the 14 patients, intravenous barbiturates, when administered with a loading dose followed by continuous infusion, were uniformly effective in aborting seizures and producing a burst-suppression EEG pattern. Other than the pupillary light reflex, most patients lost all brainstem reflexes and motor responses during therapy. Barbiturate-induced hypotension was observed in 9 of the 14 patients, and required treatment with pressors in seven cases. Three patients died early as a consequence of their underlying illness, while three others died late for reasons unrelated to the status itself or to anticonvulsant therapy. The time to recovery of function following anesthesia varied highly, spanning hours to days for return of motor function and days to weeks for cognition. Of the eight survivors, four were left with mild cognitive deficits, one returned to his baseline dementia, and three had residual encephalopathies (severe in two). We conclude that barbiturate anesthesia is an extremely effective therapy for refractory seizures. However, its use necessitates recognition of untoward cardiovascular responses and prolonged intensive care.
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PMID:Barbiturate anesthesia in the treatment of status epilepticus: clinical experience with 14 patients. 327 38

A young woman with seizures and status epilepticus sought and obtained hospitalization in at least 25 hospitals in the province of Quebec between 1980 and 1987. She was thought to have uncontrolled epilepsy; her treatment led to intoxication with anticonvulsants and once to anesthesia for three consecutive periods of 7 days each. The nonepileptic nature of her attacks was proven and a diagnosis of Munchausen's syndrome made. She was transferred to a psychiatric center where she committed suicide. We found no documented cases of epileptic chronic factitious disorder in the literature.
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PMID:Epileptic Munchausen's syndrome: a form of pseudoseizures distinct from hysteria and malingering. 341 7

In order to establish criteria for early cerebral prognosis after acute cerebral hypoxic ischemic insult, we studied 31 cases of patients presenting, during their first year of life, cardio-respiratory arrests due to SIDS (21 cases), anesthesia (4 cases), other causes (6 cases). A favourable evolution was observed in 5 cases where coma lasted less than 8 hours. Conversely unfavorable evolution was seen in the 26 patients (21 deaths, 5 sequellae) where coma lasted more than 8 hours. Among 12 patients of this group surviving after the 4th day, 9 expressed seizures or status epilepticus. The poor evolution was correlated with hyperproteinorachia during the first 24 hours and with cortico-subcortical hypodensity on CT scan. Early EEG and transfontanellar echography seemed less useful to establish a prognosis, specifically to discriminate children surviving with and without sequelae.
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PMID:[Prognostic factors in cerebral hypoxic-ischemias in infants less than a year old]. 344 55


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