Management of convulsive status epilepticus: recent updates

Byun, Jung-Ick

doi:10.47936/encephalitis.2022.00087

Cited by 4 publications

(2 citation statements)

References 45 publications

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“…Status epilepticus [13,14] is a neurological emergency caused by a variety of intracranial and extracranial disorders, including infections and tumors. Early detection and treatment of SE improves outcomes and reduces long-term complications [15].…”

Section: Discussionmentioning

confidence: 99%

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism

Flato,

Pereira,

Costa

et al. 2023

Neurology International

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Neuromonitoring is a critical tool for emergency rooms and intensive care units to promptly identify and treat brain injuries. The case report of a patient with status epilepticus necessitating orotracheal intubation and intravenous lorazepam administration is presented. A pattern of epileptiform activity was detected in the left temporal region, and intravenous Acyclovir was administered based on the diagnostic hypothesis of herpetic meningoencephalitis. The neurointensivist opted for multimodal non-invasive bedside neuromonitoring due to the complexity of the patient’s condition. A Brain4care (B4C) non-invasive intracranial compliance monitor was utilized alongside the assessment of an optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD). Based on the collected data, a diagnosis of intracranial hypertension (ICH) was made and a treatment plan was developed. After the neurosurgery team’s evaluation, a stereotaxic biopsy of the temporal lesion revealed a grade 2 diffuse astrocytoma, and an urgent total resection was performed. Research suggests that monitoring patients in a dedicated neurologic intensive care unit (Neuro ICU) can lead to improved outcomes and shorter hospital stays. In addition to being useful for patients with a primary brain injury, neuromonitoring may also be advantageous for those at risk of cerebral hemodynamic impairment. Lastly, it is essential to note that neuromonitoring technologies are non-invasive, less expensive, safe, and bedside-accessible approaches with significant diagnostic and monitoring potential for patients at risk of brain abnormalities. Multimodal neuromonitoring is a vital tool in critical care units for the identification and management of acute brain trauma as well as for patients at risk of cerebral hemodynamic impairment.

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Section: Discussionmentioning

confidence: 99%

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism

Flato,

Pereira,

Costa

et al. 2023

Neurology International

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show abstract

“…However, 31% to 47% of patients with established SE are not controlled with ASMs, a state referred to as refractory SE. 5…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and Treatment of Status Epilepticus : An Update Systematic Review

Husna,

Annisa Hasanah

2024

JARMHS

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Background: Status epilepticus (SE) is a condition resulting from the failure of the mechanisms involved in termination or the initiation of mechanisms responsible for seizure prolongation. The aim: The aim of this study to show about diagnosis and treatment of status epilepticus. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. This search approach, publications that came out between 2014 and 2024 were taken into account. Several different online reference sources, like Pubmed, SagePub, and Google Scholar were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search get 110 articles, whereas the results of our search on SagePub get 163 articles, on Google Scholar 8200 articles. Records remove before screening are 7182, so we get 2761 articles fos screening. After we screened based on record exclude, we compiled a total of 10 papers. We included five research that met the criteria. Conclusion: There are increasingly more drug options to treat SE, but rational polytherapy should consider the pharmacodynamics and kinetics of established and new antiepileptic drugs. When seizures cannot be controlled with conventional medical therapy, non-conventional treatments, including early surgical evaluation can be considered; however, high-quality evidence for these strategies are lacking. Neurointensivists are challenged to reduce secondary brain injury by managing common complications.

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Management strategies for refractory status epilepticus

Shin

2023

J Neurocrit Care

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Refractory status epilepticus (RSE) is defined as the persistence of either clinical or electrographic seizures despite the administration of appropriate doses of an initial benzodiazepine and suitable second-line antiepileptic drugs (AEDs). The Neurocritical Care Society and the American Epilepsy Society have proposed a treatment paradigm for the management of convulsive status epilepticus (CSE). The third-line therapy in refractory CSE may involve general anesthesia using intravenous midazolam, propofol, or other agents, while recent evidence supports the use of ketamine to manage RSE in both adults and children. However, although these treatment strategies are frequently employed in nonconvulsive status epilepticus (NCSE), the efficacy of AEDs and anesthetics in NCSE has not been thoroughly investigated. Recent evidence has demonstrated the safety and efficacy of newer AEDs, including levetiracetam and lacosamide, in the treatment of status epilepticus (SE) and RSE, which also encompasses NCSE. Use of multiple combinations of various intravenous AEDs can also be considered in NCSE before the administration of general anesthesia. In addition, AEDs alone exhibit limited effectiveness in managing SE for new-onset RSE (NORSE) and its subset, febrile infection-related epilepsy syndrome. Therefore, in cases of refractory status, it is imperative to explore treatment options beyond AEDs, including immunotherapy and the incorporation of a ketogenic diet. The present review suggests treatment approaches for RSE based on subgroups, including CSE, NCSE, and NORSE. A discussion of recent clinical studies on AEDs and anesthetics in the management of RSE, as well as proposed treatment methods for NORSE, is also provided.

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Management of convulsive status epilepticus: recent updates

Cited by 4 publications

References 45 publications

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism

Astrocytoma Mimicking Herpetic Meningoencephalitis: The Role of Non-Invasive Multimodal Monitoring in Neurointensivism

Diagnosis and Treatment of Status Epilepticus : An Update Systematic Review

Management strategies for refractory status epilepticus

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