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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 (SE) is defined as a seizure persisting over 10 min or repeated seizures without recovery between the attacks. SE is a frequent medical emergency with a high mortality, requiring aggressive and prompt treatment and a systematic, coordinated approach. A variety of new drugs has been introduced for the treatment of SE, including midazolam, propofol, fosphenytoin, and valproate. However, there are very few controlled clinical trials. Benzodiazepines are highly effective in terminating the SE in most patients and should be used as initial treatment. Phenytoin and Phenobarbital are employed if Benzodiazepines are not successful. The optimal therapeutic approach for the patient with refractory SE remains to be defined. Refractory SE has a poor prognosis and should be treated in a specialized ICU with EEG-monitoring. Barbiturates, propofol, and midazolam are substances that can be used alternatively.
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PMID:[Status epilepticus. Rational diagnosis and current therapeutic concepts]. 1046 80

New-onset seizures are frequent manifestations of central nervous system disorders in patients infected with human immunodeficiency virus (HIV). Seizures are more common in advanced stages of the disease, although they may occur early in the course of illness. In the majority of patients, seizures are of the generalised type. Status epilepticus is also frequent. Associated metabolic abnormalities increase the risk for status epilepticus. Cerebral mass lesions, cryptococcal meningitis, and HIV-encephalopathy are common causes of seizures. Phenytoin is the most commonly prescribed anticonvulsant in this situation, although several patients may experience hypersensitivity reactions. The prognosis of seizure disorders in HIV-infected patients depends upon the underlying cause.
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PMID:HIV infection and seizures. 1090 91

Status epilepticus (SE) is a condition characterised by frequent and prolonged epileptic seizures which frequently develop in the immature brain. Fever, metabolic disorders and subtherapeutic concentrations of antiepileptic drugs are the most common factors precipitating SE in children. Progressive neuronal damage occurs if convulsive SE persists for more than 30 minutes, with neurological, epileptic and cognitive sequelae. Unfortunately, the immature brain is more predisposed to SE and its sequelae than the mature brain. SE may be categorised as convulsive, nonconvulsive or neonatal according to its responsiveness to antiepileptic drugs. Regardless of category, the main objective in the treatment of SE is to abort the seizures and treat the inciting condition. Treatment includes: (i) monitoring of hydration, electrolyte balance, and cardiocirculatory and pulmonary functions; and (ii) rapid intravenous administration of specific antiepileptic drugs. Benzodiazepines (usually diazepam, lorazepam or midazolam) are the most effective agents for the initial treatment of convulsive and nonconvulsive SE. In particular, midazolam infusion is an effective and well tolerated therapeutic approach for the management of childhood SE, including refractory SE. Phenytoin remains an excellent agent because of its long duration of action, but it is not active in nonconvulsive SE. Fosphenytoin, a phenytoin prodrug, represents a significant advance in the treatment of children with convulsive SE. Intravenous phenytoin and intramuscular phenobarbital (phenobarbitone) are generally used in neonatal SE; other agents are rarely used.
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PMID:Treatment of status epilepticus in children. 1143 86

Our objective was to investigate the relationship between phenytoin bioavailability, enteral feeding and serum albumin levels in patients admitted to neurology/neurosurgery ITU, via case studies of three patients. The research was performed at the Walton centre for Neurology and Neurosurgery NHS Trust, Liverpool, England, and our subjects consisted of three cases admitted to ITU (1 status epilepticus, 1 post-trauma and 1 post-subarachnoid haemorrhage (SAH)). Phenytoin levels were assessed in relation to the type of feeding and serum albumin levels. We found evidence of a complex relationship between phenytoin levels, enteral feeding and serum albumin in patients in the neuro ITU setting. We conclude that, in this setting the patient's phenytoin needs to be closely monitored and treated aggressively to maintain therapeutic levels. They should also be followed up during rehabilitation to avoid toxicity.
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PMID:Problems with phenytoin administration in neurology/neurosurgery ITU patients receiving enteral feeding. 1146 22

Status epilepticus (SE) is a condition requiring emergency care. There are convulsive SE, non-convulsive SE including complex partial status and absence status, non-convulsive electric SE and pseudostatus epilepticus, although convulsive SE is the most common. Diagnosis of status epilepticus of complex partial seizures (CPS) and absence seizures was significantly delayed because delays in seeking medical attention were common. The seizures were generalized convulsive SE in 84% and CPS status in 16%, and the overall mortality rate was 15% in 41 SE patients of our study. EEG monitoring is important to make or exclude the diagnosis of SE. Diazepam is the first choice medication and effective in the management of SE, and lately, lorazepam, midazolam, propofol and pentobarbital etc as emergency therapy. Phenytoin is also considered first-line agent in the emergency management of SE. Repetitive transcranial magnetic stimulation (rTMS) led to a prolonged latency for seizure induction after an intraperitoneal injection of pentylenetetrazol (PTZ) and effectively prevented the development of status epilepticus of PTZ-induced convulsions in the rats. Our data suggest that rTMS has suppressive effects on the neuronal excitability in rats. These effects are anticonvulsive and suggest the possibility of therapeutic use of rTMS in the patients with refractory seizures.
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PMID:[Treatment of status epilepticus]. 1223 7

Selecting a specific antiepileptic drug for the treatment of seizures in those with mental retardation requires a balance of the drug's likely efficacy for both seizures and comorbid disorders versus adverse events. Phenobarbital is the most commonly used of the barbiturate drugs. Phenytoin is actually one of the best tolerated AEDs (side effects in most patients are signs of neurotoxicity). Carbamazepine is the drug of choice for many neurologists for the treatment of partial epilepsy, with a relative lack of sedation and low incidence of cosmetic, cognitive, and behavioral side effects. For more than 30 years, valproate has been available for treatment of generalized and partial seizures, convulsive or nonconvulsive. For this reason, it is used in the treatment of epilepsy in the multiply handicapped and mentally retarded. Benzodiazepines are the drug of choice for treatment of status epilepticus; however, good medical control requires early diagnosis and treatment.
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PMID:Treatment considerations: traditional antiepileptic drugs. 1260 8

Phenytoin (PHT) is a first-line drug in the treatment of status epilepticus. However, the parenteral PHT formulation is associated with administration difficulties and therefore fosphenytoin (FosPHT), a PHT pro-drug, has been developed. As the peripheral (blood) and central (cerebrospinal fluid [CSF] and brain extracellular fluid [ECF]) kinetic inter-relationship of PHT after i.v. FosPHT administration is unknown we sought to ascertain the relationship and to compare it to that of i.v. PHT. A freely behaving rat model, which allows for the concurrent and temporal sampling of blood (jugular vein), CSF (cisterna magna) and brain ECF (frontal cortex and hippocampus), was used. PHT and FosPHT were administered by i.v. infusion and blood, CSF and microdialysate samples collected at timed intervals up to 6 hours. The pharmacokinetic parameters in plasma of PHT after PHT and FosPHT (30 and 60 mg/kg) administration were indistinguishable. The PHT plasma free fraction (free/total concentration ratio) was 0.25-0.31 and 0.26-0.31 for PHT and FosPHT, respectively. Mean PHT Tmax values for CSF were 9-13 minutes. The equivalent values in the frontal cortex and hippocampal ECF were 29-34 minutes. Cmax values increased dose-dependently and were independent of whether PHT or FosPHT was administered. Furthermore the kinetic profiles of PHT for the frontal cortex and hippocampus were indistinguishable suggesting that PHT distribution in the brain is not brain region specific. Thus, overall, the central and peripheral kinetics of PHT are indistinguishable after PHT and FosPHT.
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PMID:A comparison of central brain (cerebrospinal and extracellular fluids) and peripheral blood kinetics of phenytoin after intravenous phenytoin and fosphenytoin. 1291 78

Hepatic encephalopathy represents a reversible decrease in neurological function caused by liver disease. Overall incidence of seizures in hepatic encephalopathy varies between 2% and 33%. Non-convulsive status epilepticus may be particularly common in these patients. Psychiatric disturbances manifest as agitation, personality change, delusions, etc. Aims of seizure management include treatment of basic disease, correction of precipitant factors, imaging of head, and choice of a pharmacologically safe agent. It is important to consider non-convulsive status epilepticus and rule it out by an EEG. Absolute data for safety profile of drugs in liver disease is still not clear, as changes of pharmacokinetics make choice of drugs difficult. Free drug concentrations may be higher, making plasma concentration monitoring essential in such circumstances. A single seizure may not require therapy. However when started, antiepileptic drugs are usually discontinued early. Drugs with sedative effects are best avoided because of a risk of precipitating coma. Phenytoin and gabapentin are relatively preferred drugs; however, monitoring of drug levels is desirable. Management of agitation includes physical restraint and medication. Benzodiazepines are best avoided. Haloperidol is a safer choice in the presence of liver disease. Overall management of neuropsychiatric state aims at management of underlying pathology, the resolution of which leads to improvement in the clinical symptomatology.
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PMID:Management of agitation and convulsions in hepatic encephalopathy. 1502 57

The incidence of convulsive status epilepticus in children is approximately 20-50/100,000/year, and is an emergency requiring prompt medical intervention. Prolonged seizures lasting over 5 min are unlikely to stop spontaneously, and time-to-treatment influences treatment response. Prolonged seizures should thus be treated as early status epilepticus. Mortality and morbidity increase significantly with the length of ongoing seizure activity, especially after 60 min. Benzodiazepines remain the first-line drug therapy due to their rapid onset of action. Recent studies imply that buccal midazolam is more effective and easier to administer than rectal diazepam. Phenytoin/fosphenytoin and phenobarbital administered intravenously remain the second-line treatments of choice, whilst barbiturates and midazolam as intravenous anesthetics are used for third-line treatment. Electroencephalogram monitoring is essential to evaluate the electrophysiologic treatment response and depth of anesthesia, especially in refractory status epilepticus. In the future, more individualized protocols and pathways are needed in order to optimize treatment responses. Randomized clinical trials are needed to evaluate new treatment protocols, which should not only stop the seizures more effectively but also be safer and include some neuroprotective elements to halt the cascade of neuronal injury and minimize the risk for neurologic morbidity caused by the convulsive status epilepticus.
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PMID:Pharmacologic management of convulsive status epilepticus in childhood. 1627 35

The authors would like to evaluate the incidence, clinical manifestation, the appropriateness of treatment, and outcome of seizure at the emergency department (ED). All charts of patients who visited the ED of Srinagarind Hospital from 1 January 2003 to 31 December 2003 were reviewed. The profiles of patients and management at the ED were recorded. There were 33,508 cases who visited the ED with 104 cases (0.31%) presenting with seizure. Four cases (3.9%) were diagnosed as status epilepticus. Generalized tonic-clonic seizure was the most common type. Poor antiepileptic drug (AED) compliance with the low AED level was the main precipitating factor. The normal physical examination and routine laboratory tests were normal in the majority of patients. Phenytoin intravenous loading was the commonest initial treatment even in patients with non-status epilepticus. Fourteen patients (13.5%) were treated with intravenous diazepam even though seizures were discontinued. Sixty patients (57.7%) were discharged after seizure was controlled. The advice in seizure control was recorded in only 11 cases (10.6%). From this review, 12 patients presented at the ED for continuing medication without any seizures. In conclusion, seizure at the ED should be treated more appropriately with both laboratory investigation and drug treatment. Futhermore, patient education should be implemented.
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PMID:Seizure presenting to the emergency department, Srinagarind Hospital. 1669 21


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