Balancing the risks and benefits of anesthetics in status epilepticus

Sutter, Raoul; Jünger, Anja L.; Baumann, Sira M; Grzonka, Pascale; Stefano, Pia De; Fisch, Urs

doi:10.1016/j.yebeh.2022.109027

Cited by 2 publications

(2 citation statements)

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“…Status epilepticus is a condition that has long-term effects (especially if it occurs for more than 30 minutes), such as nerve death, nerve injury, and changes in nerve tissue, depending on the type and duration of the seizure. [21][22][23] Classification of status epilepticus is based on 4 axes: semiology, etiology, EEG correlation, and age. Therapy for status epilepticus should be given as soon as possible to stop the seizures before permanent nerve cell damage occurs.…”

Section: Discussionmentioning

confidence: 99%

The Role of Midazolam on Status Epilepticus: Systematic Review

Firdha,

Puspamaniar,

Machin

2023

dmj

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Background: Status epilepticus is a condition that results either in the failure of the mechanisms responsible for stopping seizures or in initiating mechanisms that cause seizures to be abnormally prolonged. Benzodiazepine is the first-line therapy for status epilepticus. The three usually used Benzodiazepines are Lorazepam, diazepam, and midazolam. Objective: This systematic review was undertaken to determine midazolam's role in managing patients with status epilepticus. Methods: A systematic search from PubMed, Science Direct, and Cochrane was conducted with predetermined keywords. Studies in randomized controlled trials assessing the impact of midazolam on epileptic status were included in the inclusion criteria. Articles are published in English, and the full text is accessible. The authors independently extracted data and assessed the risk of bias for each included study. Results: Of 6410 studies obtained from the search results, 13 studies were found that were relevant and matched the inclusion criteria. Benzodiazepines are the first line of SE therapy in an emergency. This group works by inhibiting GABA receptors and has a rapid effect in stopping seizures. Midazolam can be given intravenously, intramuscularly, or transmucosal (nasal, buccal, or rectal). Intravenous midazolam may be a good choice because of its short onset of action and, therefore, can effectively stop seizures. Conclusion: Effective and safe results have been seen with each Midazolam administration method. This suggests that Midazolam may be an excellent therapeutic option for SE. However, the type of Midazolam administration can be adjusted according to the guidelines and drug availability in each country.

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Section: Discussionmentioning

confidence: 99%

The Role of Midazolam on Status Epilepticus: Systematic Review

Firdha,

Puspamaniar,

Machin

2023

dmj

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“…In RSE and SRSE patients, treatment often requires aggressive doses of intravenous anesthetic drugs (IVADs). Prolonged IVAD use and intubation can be associated with serious complications such as infection, septic shock and increased risk of mortality ( 8 , 9 ). Alternatively, surgical resection may be beneficial in a subset of patients with a clear evidence of a focal lesion and concordant semiology, imaging and electroencephalography (EEG) findings ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis

Niazi,

Han,

Stamm

et al. 2024

Front. Neurol.

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BackgroundRefractory (RSE) and super-refractory status epilepticus (SRSE) are serious neurological conditions requiring aggressive management. Beyond anesthetic agents, there is a lack of evidence guiding management in these patients. This systematic review and individual participant data meta-analysis (IPDMA) seeks to evaluate and compare the currently available surgical techniques for the acute treatment of RSE and SRSE.MethodsA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data (PRISMA-IPD). Only patients who underwent surgery while in RSE and SRSE were included. Descriptive statistics were used to compare various subgroups. Multivariable logistic regression models were constructed to identify predictors of status epilepticus (SE) cessation, long-term overall seizure freedom, and favorable functional outcome (i.e., modified Rankin score of 0–2) at last follow-up.ResultsA total of 87 studies including 161 participants were included. Resective surgery tended to achieve better SE cessation rate (93.9%) compared to non-resective techniques (83.9%), but this did not reach significance (p = 0.071). Resective techniques were also more likely to achieve seizure freedom (69.1% vs. 34.4%, p = <0.0001). Older age at SE (OR = 1.384[1.046–1.832], p = 0.023) was associated with increased likelihood of SE cessation, while longer duration of SE (OR = 0.603[0.362–1.003], p = 0.051) and new-onset seizures (OR = 0.244[0.069–0.860], p = 0.028) were associated with lower likelihood of SE cessation, but this did not reach significance for SE duration. Only shorter duration of SE prior to surgery (OR = 1.675[1.168–2.404], p = 0.0060) and immediate termination of SE (OR = 3.736 [1.323–10.548], p = 0.014) were independently associated with long-term seizure status. Rates of favorable functional outcomes (mRS of 0–2) were comparable between resective (44.4%) and non-resective (44.1%) techniques, and no independent predictors of outcome were identified.ConclusionOur findings suggest that emergency neurosurgery may be a safe and effective alternative in patients with RSE/SRSE and may be considered earlier during the disease course. However, the current literature is limited exclusively to small case series and case reports with high risk of publication bias. Larger clinical trials assessing long-term seizure and functional outcomes are warranted to establish robust management guidelines.

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Balancing the risks and benefits of anesthetics in status epilepticus

Cited by 2 publications

References 39 publications

The Role of Midazolam on Status Epilepticus: Systematic Review

The Role of Midazolam on Status Epilepticus: Systematic Review

Outcome of emergency neurosurgery in patients with refractory and super-refractory status epilepticus: a systematic review and individual participant data meta-analysis

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