What’s new in status epilepticus?

Rossetti, Andrea O.; Bleck, Thomas P.

doi:10.1007/s00134-014-3363-z

Cited by 26 publications

(26 citation statements)

References 18 publications

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“…Patients with SE, defined as continuous convulsions for !5 min or recurrent seizures without recovery of consciousness to baseline between the attacks Patients with subtle SE, defined as the presence of coma and ictal discharges on electroencephalogram (EEG), along with subtle convulsive movements [8] Patients whose expenditure during hospitalization could be retrieved from the computerized hospital information system…”

Section: Inclusion Criteriamentioning

confidence: 99%

Cost of status epilepticus in a tertiary care hospital in India

Misra

Kalita

Bhoi

et al. 2015

Seizure

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Section: Inclusion Criteriamentioning

confidence: 99%

Cost of status epilepticus in a tertiary care hospital in India

Misra

Kalita

Bhoi

et al. 2015

Seizure

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“…As about one-third of patients still continue seizing despite the first two treatment lines, thus evolving to refractory SE, and half of these subsequently develop super-refractory SE, it seems important to consider further treatment alternatives, such as other anesthetics and AEDs, vagal nerve stimulation, transcranial magnetic stimulation, electroconvulsive treatment, mild hypothermia or resective surgery [10,33,40]. In particular, there has been a recent reappraisal of ketamine, an anesthetic with NMDA antagonist properties, which seems promising [41,42] in view of the GABA-resistance and glutamate hyperactivity in ongoing experimental SE [43,44].…”

Section: Framing the Problem From The Clinical Sidementioning

confidence: 99%

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application

Vezzani

Dingledine

Rossetti

2015

Expert Review of Neurotherapeutics

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Status epilepticus (SE) is a life-threatening neurological emergency often refractory to available treatment options. It is a very heterogeneous condition in terms of clinical presentation and causes, which besides genetic, vascular and other structural causes also include CNS or severe systemic infections, sudden withdrawal from benzodiazepines or anticonvulsants and rare autoimmune etiologies. Treatment of SE is essentially based on expert opinions and antiepileptic drug treatment per se seems to have no major impact on prognosis. There is, therefore, urgent need of novel therapies that rely upon a better understanding of the basic mechanisms underlying this clinical condition. Accumulating evidence in animal models highlights that inflammation ensuing in the brain during SE may play a determinant role in ongoing seizures and their long-term detrimental consequences, independent of an infection or auto-immune cause; this evidence encourages reconsideration of the treatment flow in SE patients.

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“…1,2 SE that continues despite the administration of one benzodiazepine and one AED, in adequate doses, is commonly referred to as refractory status epilepticus (RSE). Beyond these 3 lines exist a series of options, including further anesthetics (such as ketamine), immunomodulation, ketogenic diet, and physical methods (such as electrical vagus nerve stimulation, electroconvulsive treatment, hypothermia, and repetitive transcranial magnetic stimulation).…”

Section: Treatment Of Refractory and Super-refractory Status Epilepticusmentioning

confidence: 99%

Place of neurosteroids in the treatment of status epilepticus

Rossetti

2018

Epilepsia

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The treatment of refractory or super-refractory status epilepticus (SE) currently relies on low-evidence strategies, including general anesthetics to induce pharmacologic coma, ketogenic diet, immunosuppression, and other physical measures. Besides the formal uncertainty regarding efficacy, concerns have been about tolerability. In this situation, identification of alternative, higher evidence treatments is urgently needed. Allopregnanolone is an endogenous neurosteroid exerting a positive allosteric modulation on γ-aminobutyric acid (GABA) receptors. In animal experiments it has been demonstrated that this neurosteroid displays relevant antiseizure properties in a variety of SE models, and that the tolerance to benzodiazepines, relying on receptor internalization, does not affect its action. An experimental clinical use in patients with SE older than 2 years was initated more than 5 years ago. Being a naturally occurring compound, no relevant adverse events are expected, and until now its safety profile appears reassuring. Preliminary results of a phase I/II trial seemed promising, but a recent well-designed randomized, placebo-controlled trial could not find any difference in terms of efficacy; tolerability seemed nevertheless good. Patients with refractory and super-refractory SE still deserve further well-designed studies to improve current treatment options.

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What’s new in status epilepticus?

Cited by 26 publications

References 18 publications

Cost of status epilepticus in a tertiary care hospital in India

Cost of status epilepticus in a tertiary care hospital in India

Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application

Place of neurosteroids in the treatment of status epilepticus

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