Status Epilepticus: A Clinical Perspective !NEW!
This expanded edition represents the state of the art and captures many changes in our understanding of status epilepticus over the past decade. Varied characteristics and treatment approaches, the growing use of continuous EEG monitoring, and insights into the underlying biology and pathophysiology of convulsive and nonconvulsive SE are covered in depth. Authored by leading neurologists, epileptologists, and clinical neurophysiologists from around the world, this volume prepares the clinician to confront these multifaceted, sometimes subtle, and occasionally life-threatening conditions.
Status Epilepticus: A Clinical Perspective
This article outlines the consensus proposal on diagnosis of epilepsy in dogs by the International Veterinary Epilepsy Task Force. The aim of this consensus proposal is to improve consistency in the diagnosis of epilepsy in the clinical and research settings. The diagnostic approach to the patient presenting with a history of suspected epileptic seizures incorporates two fundamental steps: to establish if the events the animal is demonstrating truly represent epileptic seizures and if so, to identify their underlying cause. Differentiation of epileptic seizures from other non-epileptic episodic paroxysmal events can be challenging. Criteria that can be used to make this differentiation are presented in detail and discussed. Criteria for the diagnosis of idiopathic epilepsy (IE) are described in a three-tier system. Tier I confidence level for the diagnosis of IE is based on a history of two or more unprovoked epileptic seizures occurring at least 24 h apart, age at epileptic seizure onset of between six months and six years, unremarkable inter-ictal physical and neurological examination, and no significant abnormalities on minimum data base blood tests and urinalysis. Tier II confidence level for the diagnosis of IE is based on the factors listed in tier I and unremarkable fasting and post-prandial bile acids, magnetic resonance imaging (MRI) of the brain (based on an epilepsy-specific brain MRI protocol) and cerebrospinal fluid (CSF) analysis. Tier III confidence level for the diagnosis of IE is based on the factors listed in tier I and II and identification of electroencephalographic abnormalities characteristic for seizure disorders. The authors recommend performing MRI of the brain and routine CSF analysis, after exclusion of reactive seizures, in dogs with age at epileptic seizure onset 6 years, inter-ictal neurological abnormalities consistent with intracranial neurolocalisation, status epilepticus or cluster seizure at epileptic seizure onset, or a previous presumptive diagnosis of IE and drug-resistance with a single antiepileptic drug titrated to the highest tolerable dose.
Reactive seizures can result from systemic metabolic disorders (e.g., hypoglycaemia, electrolyte disorders, portosystemic shunt resulting in hepatic encephalopathy) or from intoxications (e.g., carbamates, organophosphates, lead poisoning, ethylene glycol toxicity, metaldehyde, strychnine). The history and clinical presentation may help the clinician to suspect a particular aetiology, although diagnosing certain intoxications can be quite challenging. In a recent study the most frequent cause of reactive seizures were intoxications (39 %, 37/96 of dogs) and hypoglycaemia (32 %, 31/96 of dogs) . In this study, 41 % (39/96) of dogs were presented in status epilepticus . Another study showed that dogs with reactive seizures caused by exogenous toxicity have a significantly higher risk of developing status epilepticus, particularly as first manifestation of a seizure disorder, than dogs with other seizure aetiologies . Dogs with poisoning had a 2.7 times higher risk of presenting in status epilepticus at seizure onset than dogs with IE or structural epilepsy . The clinical presentation in dogs with metabolic and toxic disorders is variable and depends on the underlying aetiology. Toxic disorders often have an acute (
This guideline addresses the emergency management of convulsive status epilepticus (CSE) in children and infants older than one month of age. It replaces a previous position statement from 2011, and includes a new treatment algorithm and table of recommended medications based on new evidence and reflecting the evolution of clinical practice over the past several years. This statement emphasizes the importance of timely pharmacological management of CSE, and includes some guidance for diagnostic approach and supportive care.
Our intensive one-year fellowship program focusing on EEG/Epilepsy provides clinical and didactic education about the multidisciplinary care of patients with epilepsy. Trainees will learn how to read routine, ambulatory, and long-term video EEG studies in both ICU and non-ICU settings under faculty supervision by both adult and pediatric epileptologists. You learn about the differential diagnosis of seizures, characterizing and recognizing various epilepsy syndromes, complex interictal and ictal patterns, managing convulsive and non-convulsive status epilepticus, and the medical and surgical treatment of epilepsy.
Patients Among 127 consecutive episodes (107 patients) of status epilepticus, we identified episodes that were refractory to first-line and second-line antiepileptic drugs, needing induced coma with barbiturates, propofol, or midazolam for clinical management.
Main Outcome Measures Short-term mortality and prevalence of return to functional baseline after the acute episode of status epilepticus were analyzed in relation to demographic and clinical variables and to treatment option (antiepileptic agents and EEG burst suppression).
Results Forty-nine episodes of RSE (47 patients) were found, occurring more frequently in incident than in recurrent episodes of status epilepticus (P = .06). Mortality was 23% for patients with RSE and 8% for those without RSE (P = .05). Return to baseline occurred more often in the non-RSE group (P = .04). In 20 (61%) of 33 monitored episodes, EEG burst suppression was achieved. Demographic data, clinical variables, and outcome did not differ significantly with the various coma-inducing agents or between episodes with and without EEG burst suppression.
Conclusions Refractory status epilepticus is more prevalent in incident than in recurrent status epilepticus and is associated with higher mortality; clinical status is less likely to return to baseline than with non-RSE. Outcome was independent of the specific coma-inducing agents used and the extent of EEG burst suppression, suggesting that the underlying cause represents its main determinant.
New-onset refractory status epilepticus (NORSE) is a rare clinical diagnosis. Autoimmune encephalitis and paraneoplastic encephalitis are the most common identifiable etiologies of NORSE; of the known autoimmune encephalitides,
Acute complications of seizures include physical trauma and CNS tissue damage due to hyperthermia, cardiorespiratory deficits, or excitatory toxicity. Status epilepticus is a potentially life-threatening condition characterized by continuous seizure activity for more than 5 minutes that requires immediate management and stabilization. Acute seizures and status epilepticus in adults and children are most often initially treated with parenteral benzodiazepines, and then with the addition of other parenteral antiepileptic drugs (e.g., fosphenytoin) if there is no resolution. Rapidly reversible causes of seizures (e.g., hypoglycemia) should also be managed concurrently. The underlying cause is investigated based on a combination of clinical evaluation (e.g., seizure classification, identifying seizure triggers), laboratory studies, and neuroimaging. Electroencephalography (EEG) can provide additional evidence to support the diagnosis, although a normal EEG between seizures does not rule out epilepsy. Important antiepileptic drugs for the long-term treatment of epilepsy include lamotrigine (first-line treatment in focal seizures), valproate (first-line treatment in generalized seizures), and ethosuximide (first-line treatment in absence seizures). Appropriate medical treatment allows the majority of patients to remain seizure\u2011free in the long term and prevents long-term complications such as psychiatric conditions (e.g., anxiety, depression, psychosis), sleep disorders, and sudden unexpected death in epilepsy (SUDEP); however, patients must be monitored for adverse effects of medications (e.g., bone disease). Epilepsy in certain groups (e.g., pregnant individuals, children) also may require specific considerations for management.
The term myoclonic status epilepticus and its variations, including prolonged myoclonus, status myoclonus, status myoclonicus, and myoclonic status, have been used to describe a variety of clinical states that have in common a prolonged period of frequent spontaneous myoclonic jerks. Myoclonic status may be associated with a wide range of etiologies, including anoxic brain injury, toxic-metabolic encephalopathies, and exacerbations of certain epilepsy syndromes. The clinical presentation and significance of frequent myoclonic jerks differs greatly by etiology. In this article, the authors discuss the classification, clinical presentations, etiologies, and management of conditions typically categorized as subtypes of myoclonic status epilepticus. They also discuss controversies of prognostic significance and management of myoclonic status epilepticus following anoxic brain injury, including data to suggest possible clinical and EEG predictors for neurologic outcomes. 041b061a72