Bowel Ischemia in Refractory Status Epilepticus: Report of Two Cases and Review of the Literature

Rizek, Philippe; Ikeda, Kristin M.; Mele, Tina; García, B Torres; Gofton, Teneille

doi:10.1007/s12028-015-0181-2

Cited by 5 publications

(2 citation statements)

References 11 publications

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“…Systemic manifestations of on-going seizure activity in SE include fever, acid-base imbalance, cardiopulmonary complications, irreversible cerebral injury, bowel ischaemia and acute non-oliguric renal failure. [57][58][59][60] Common acid-base abnormalities include metabolic acidosis from excessive muscular activity, whereas respiratory acidosis may result from aspiration and decreased respiratory drive. Pulmonary complications including pneumonia (both health-acquired and ventilator-associated), pulmonary effusion, atelectasis, consolidation and neurogenic pulmonary oedema are also common, requiring mechanical ventilation, parenteral antibiotics and repeated bronchoscopies.…”

Section: Treatment Of Non-convulsive Status Epilepticusmentioning

confidence: 99%

“…The possible aetiologies include RSE itself, systemic hypotension, vasopressor use, general anaesthesia (continuous barbiturate infusions), and abnormal cardiac function. [59] Continuous seizures may cause muscle damage leading to acute non-oliguric renal failure from rhabdomyolysis and myoglobinuria thus, requiring early renal replacement therapy. [60] Use of continuous infusion AEDs results in considerable side effects and frequently requires assisted ventilation and vasopressor therapy with predicted poor outcome and death.…”

Section: Treatment Of Non-convulsive Status Epilepticusmentioning

confidence: 99%

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Intensive care management of status epilepticus

Gupta

2016

Journal of Neuroanaesthesiology and Critical Care

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Status epilepticus (SE) is a life-threatening neurological emergency that requires prompt diagnosis and treatment. SE may be classified into convulsive and non-convulsive types, based on the presence of rhythmic jerking of the extremities. Clinically, tonic-clonic convulsive SE (CSE) is divided into four subsequent stages: Early, established, refractory and super-refractory. Initial elements of resuscitation include airway protection, haemodynamic resuscitation and seizure control. Further treatment should then be guided by the diagnostic workup. Rapid treatment of early SE is achieved with intravenous (IV) lorazepam or intramuscular midazolam. In established SE, IV antiepileptic drugs (AEDs) (phenytoin/fosphenytoin, valproate, levetiracetam, phenobarbital) are most commonly used, but there is no Class I evidence for choosing one over the other. Considered overall, cumulative data from the literature are consistent with valproate and levetiracetam, being a safe and effective therapeutic alternative to phenobarbital and phenytoin for treatment of established SE. Refractory SE (RSE) and super-RSE are treated with anaesthetic medications (propofol, midazolam, thiopental/pentobarbital, ketamine), non-anaesthetic drugs (lidocaine, magnesium, pyridoxine), AEDs (levetiracetam, lacosamide, topiramate, lacosamide, pregabalin, gabapentin) and other cause-directed treatments with low success rates. Potential non-pharmacologic interventions to be considered in super-RSE include hypothermia, electroconvulsive therapy, ketogenic diet, immunomodulatory treatments, emergency resective epilepsy surgery, cerebrospinal fluid drainage and vagal nerve or deep brain stimulation or transcranial magnetic stimulation. Diagnosis of non-CSE requires continuous electroencephalography and involves a high index of suspicion in all patients with an altered mental status of unclear cause or with a prolonged postictal state. Treatment options include addressing underlying causes and aggressive pharmacologic interventions with a benzodiazepine, phenytoin and valproate.

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Section: Treatment Of Non-convulsive Status Epilepticusmentioning

confidence: 99%

Section: Treatment Of Non-convulsive Status Epilepticusmentioning

confidence: 99%

Intensive care management of status epilepticus

Gupta

2016

Journal of Neuroanaesthesiology and Critical Care

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Designing New Studies in Status Epilepticus

Lee

Hahn

2017

Status Epilepticus

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Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety

et al. 2016

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Current management guidelines for refractory status epilepticus (RSE) recommend the use of intravenous continuous anesthetic therapy, but there is little evidence to guide the selection of the most efficacious and safest drug. We conducted a retrospective study to evaluate the efficacy and safety of midazolam versus thiopental for treatment of RSE. Retrospective case-control series of prospectively identified patients treated with midazolam or thiopental for RSE between January 2007 and December 2014. The primary outcome was control of RSE. Secondary outcomes included the rate of adverse events, intensive care unit (ICU) and hospital length of stay, hospital mortality and long-term neurological outcome, assessed with the extended Glasgow outcome scale (GOS-E) at discharge and at six 6 months. A total of 33 patients were included, 19 treated with midazolam and 14 with thiopental. Groups were similar for demographic data, clinical variables, comorbidity and the underlying cause of RSE. The rate of control of SE did not differ between groups (63 vs. 64 %). Adverse events including hypotension (mean arterial pressure <70 mmHg) requiring vasopressors, infections, anemia requiring red blood cells transfusion, leucopenia (<4000/mm(3)), and hyponatremia (<130 mEq/l) were more frequent during thiopental infusion. Furthermore, patients treated with midazolam had a shorter median ICU length of stay (6 vs. 15 days; p = 0.02) and better GOS-E at 6 months (8 [8] vs. 4 [4, 5]; p = 0.01). These findings suggest that continuous midazolam administration is as efficacious as thiopental infusion for the treatment of RSE; however, midazolam was associated with a significantly lower number of adverse events. These findings should be confirmed in larger multicenter trials.

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Bowel Ischemia in Refractory Status Epilepticus: Report of Two Cases and Review of the Literature

Cited by 5 publications

References 11 publications

Intensive care management of status epilepticus

Intensive care management of status epilepticus

Designing New Studies in Status Epilepticus

Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety

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