Phenomenology of prolonged febrile seizures

Shinnar, Shlomo; Hesdorffer, Dale C.; Nordli, Douglas R.; Pellock, John M.; O’Dell, Christine; Lewis, Darrell V.; Frank, L. Matthew; Moshé, Solomon L.; Epstein, Leon G.; Marmarou, Anthony; Bagiella, Emilia

doi:10.1212/01.wnl.0000310774.01185.97

Cited by 166 publications

(158 citation statements)

References 33 publications

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“…It has certainly been observed that the longer a seizure continues, the less likely it is to stop [28][29][30]; this is consistent with the concept that seizure activity itself can exhaust seizure inhibitory mechanisms (or strengthen seizure-promoting processes). Most people with status epilepticus have their status epilepticus stopped with initial therapy or even with second-or third-line therapies.…”

Section: Nature Of Refractory Status Epilepticussupporting

confidence: 73%

Pathophysiology of status epilepticus

Walker¹

2018

Neuroscience Letters

104

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Status epilepticus (SE) is the maximal expression of epilepsy with a high morbidity and mortality. It occurs due to the failure of mechanisms that terminate seizures.Both human and animal data indicate that the longer a seizure lasts, the less likely it is to stop. Recent evidence suggests that there is a critical transition from an ictal to a post-ictal state, associated with a transition from a spatio-temporally desynchronized state to a highly synchronized state, respectively.As SE continues, it becomes progressively resistant to drugs, in particular benzodiazepines due partly to NMDA receptor-dependent internalization of GABA (A) receptors. Moreover, excessive calcium entry into neurons through excessive NMDA receptor activation results in activation of nitric oxide synthase, calpains, and NADPH oxidase. The latter enzyme plays a critical part in the generation of seizuredependent reactive oxygen species. Calcium also accumulates in mitochondria resulting in mitochondrial failure (decreased ATP production), and opening of the mitochondrial permeability transition pore. Together these changes result in status epilepticus-dependent neuronal death via several pathways. Multiple downstream mechanisms including inflammation, break down of the blood-brain barrier, and changes in gene expression can contribute to later pathological processes including chronic epilepsy and cognitive decline.

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Section: Nature Of Refractory Status Epilepticussupporting

confidence: 73%

Pathophysiology of status epilepticus

Walker¹

2018

Neuroscience Letters

104

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“…Although class 1 studies were available for some areas such as management of simple febrile seizures, the optimal outcome of febrile status remained under investigation, awaiting studies such as those from the FEBSTAT (Consequences of Prolonged Febrile Seizures) study group to collate prospective and longitudinal data. 29 EEG is most useful when confirmatory data are recorded, but failure to detect epileptiform activity may not exclude epilepsy without good clinical correlation. 30 Access to EEG, with accurate interpretation, is challenging even in resource-equipped settings, and would often be considered a tertiary intervention.…”

Section: Discussion Of the Recommendationsmentioning

confidence: 99%

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

et al. 2015

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Summary Evidence‐based guidelines, or recommendations, for the management of infants with seizures are lacking. A Task Force of the Commission of Pediatrics developed a consensus document addressing diagnostic markers, management interventions, and outcome measures for infants with seizures. Levels of evidence to support recommendations and statements were assessed using the American Academy of Neurology Guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The report contains recommendations for different levels of care, noting which would be regarded as standard care, compared to optimal care, or “state of the art” interventions. The incidence of epilepsy in the infantile period is the highest of all age groups (strong evidence), with epileptic spasms the largest single subgroup and, in the first 2 years of life, febrile seizures are the most commonly occurring seizures. Acute intervention at the time of a febrile seizure does not alter the risk for subsequent epilepsy (class 1 evidence). The use of antipyretic agents does not alter the recurrence rate (class 1 evidence), and there is no evidence to support initiation of regular antiepileptic drugs for simple febrile seizures (class 1 evidence). Infants with abnormal movements whose routine electroencephalography (EEG) study is not diagnostic, would benefit from video‐EEG analysis, or home video to capture events (expert opinion, level U recommendation). Neuroimaging is recommended at all levels of care for infants presenting with epilepsy, with magnetic resonance imaging (MRI) recommended as the standard investigation at tertiary level (level A recommendation). Genetic screening should not be undertaken at primary or secondary level care (expert opinion). Standard care should permit genetic counseling by trained personal at all levels of care (expert opinion). Genetic evaluation for Dravet syndrome, and other infantile‐onset epileptic encephalopathies, should be available in tertiary care (weak evidence, level C recommendation). Patients should be referred from primary or secondary to tertiary level care after failure of one antiepileptic drug (standard care) and optimal care equates to referral of all infants after presentation with a seizure (expert opinion, level U evidence). Infants with recurrent seizures warrant urgent assessment for initiation of antiepileptic drugs (expert opinion, level U recommendation). Infantile encephalopathies should have rapid introduction and increment of antiepileptic drug dosage (expert opinion, level U recommendation). There is no high level evidence to support any particular current agents for use in infants with seizures. For focal seizures, levetiracetam is effective (strong evidence); for generalized seizures, weak evidence supports levetiracetam, valproate, lamotrigine, topiramate, and clobazam; for Dravet syndrome, strong evidence supports that stiripentol is effective (in combination with valproate and clobazam), whereas weak evidence supports that topiramate, zonisamide,...

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“…Febstat, a prospective multicenter study, is investigating the relationships between HHV6 and 7, febrile status epilepticus, MRI changes, and later epilepsy (46).…”

Section: Human Herpes Virus 6bmentioning

confidence: 99%

Epilepsy and Viral Infections

Theodore

2014

Epilepsy Curr

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Phenomenology of prolonged febrile seizures

Cited by 166 publications

References 33 publications

Pathophysiology of status epilepticus

Pathophysiology of status epilepticus

Summary of recommendations for the management of infantile seizures: TaskForceReport for theILAE Commission ofPediatrics

Epilepsy and Viral Infections

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