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1.
Braz. j. biol ; 83: e237412, 2023. tab, graf
Article in English | MEDLINE, LILACS, VETINDEX | ID: biblio-1355854

ABSTRACT

Abstract Only few studies have focus on animals that received Pilocarpine (Pilo) and did not develop behavioral status epilepticus (SE) and, whether they may become epileptic in the model's chronic phase. Previews works observed mossy fiber sprouting in the hippocampus of Non-SE (NSE) rats, while others observed spontaneous and recurrent seizures (SRS) 6 - 8 months after animals received Pilo. It is known that neuronal excitability is influenced by female hormones, as well as, the occurrence of SE in castrated and non-castrated female rats. However, it is not known whether females that received Pilo and did not show SE, may have SRS. The aim of this work was to investigate whether castrated and non-castrated female rats that did not show behavioral SE after Pilo, will develop SRS in the following one-year. For that, animals received 360 mg/kg of Pilo and were video monitored for 12 months. SE females from castrated and non-castrated groups became epileptic since the first month after drug injection. Epileptic behaviors were identified watching video monitoring recordings in the fast speed. Castrated and Non-castrated NSE animals showed behaviors resembling seizures described by Racine Scale stages 1 - 3. Motor alterations showed by NSE groups could be observed only when recordings were analyzed in slow speed. In addition, behavioral manifestations as, rhythmic head movements, sudden head movements, whole body movements and immobility were also observed in both, SE and NSE groups. We concluded that NSE female rats may have become epileptic. Adding to it, slow speed analysis of motor alterations was essential for the observation of NSE findings, which suggests that possibly many motor alterations have been underestimated in epilepsy experimental research.


Resumo Poucos são os estudos com foco em animais que receberam Pilocarpina (Pilo) e não desenvolveram status epilepticus (SE) comportamental e, se os mesmos se tornarão epilépticos na fase crônica do modelo. Autores observaram o brotamento das fibras musgosas no hipocampo de ratos Não-SE (NSE), enquanto outros observaram crises espontâneas e recorrentes (CER) 6 - 8 meses após receberam a droga. A excitabilidade neuronal é influenciada pelos hormônios femininos e, da mesma forma, a ocorrência de SE em ratas castradas e não-castradas. Entretanto, não é sabido se as fêmeas que não apresentam SE terão CER. O objetivo deste trabalho foi investigar se fêmeas castradas e não castradas que não tiveram SE comportamental após a injeção de Pilo desenvolverão CER dentro de um ano. Para isto, os animais receberam 360 mg/kg de Pilo e foram videomonitorados por 12 meses. As fêmeas SE castradas e não-castradas se tornaram epilépticas desde o primeiro mês pós Pilo. O comportamento epiléptico foi identificado assistindo as gravações na velocidade rápida. As fêmeas NSE castradas e não-castradas apresentaram comportamentos similares aos estágios 1 - 3 da Escala de Racine. As alterações motoras nestes grupos (NSE) foram observadas apenas quando as videomonitoração foi analisada na velocidade lenta. Além destas, manifestações comportamentais como movimentos rítmicos da cabeça, movimentos súbitos da cabeça, movimentos de todo o corpo e imobilidade também foram observadas em ambos grupos, SE e NSE. Concluímos que as fêmeas NE podem ter se tornado epilépticas. Adicionado a isto, a análise das alterações motoras na velocidade lenta foi essencial para a observação dos achados das fêmeas NSE, o que sugere que possivelmente muitas alterações motoras têm sido subestimados na pesquisa em epilepsia experimental.


Subject(s)
Animals , Female , Rats , Pilocarpine/toxicity , Seizures/chemically induced , Status Epilepticus/chemically induced , Rats, Wistar , Muscarinic Agonists/toxicity , Models, Theoretical
2.
Rev. bras. ter. intensiva ; 33(4): 635-639, out.-dez. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1357187

ABSTRACT

RESUMO Define-se estado epiléptico super-refratário como ocorrência de crises epilépticas persistentes ou que ressurgem em condições de infusão endovenosa de anestésicos por mais de 24 horas. Nos últimos anos, chamou-se a atenção para os potenciais benefícios de uma dieta cetogênica para o controle de tais pacientes. Contudo, o papel específico dessa estratégia na população adulta, assim como o mecanismo de ação, a melhor ocasião para iniciar e o manejo das complicações, permanece como assunto amplamente debatível. Relatamos uma série de casos com três pacientes que foram internados em unidade de terapia intensiva em razão de estado epiléptico super-refratário e tratados com utilização de dieta cetogênica; também propomos uma abordagem clínica para início, transição e manejo das intercorrências clínicas desta intervenção.


Abstract Super-refractory status epilepticus is defined as seizures that persist or reemerge in the setting of an intravenous anesthetic infusion for more than 24 hours. In recent years, attention has been driven to the potential benefits of a ketogenic diet in the management of these patients. However, the specific role of this strategy in the adult population, as well as its underlying mechanism of action and optimal time for the initiation and management of complications, remain widely debatable. We report a case series of three patients admitted to an intensive care unit due to super-refractory status epilepticus who were managed with a ketogenic diet and propose a clinical approach to its initiation, transition, and management of clinical intercurrences.


Subject(s)
Humans , Adult , Status Epilepticus , Diet, Ketogenic , Seizures , Critical Care , Intensive Care Units
3.
Rev. bras. ter. intensiva ; 33(3): 440-444, jul.-set. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1347288

ABSTRACT

RESUMO Objetivo: Identificar evidências atuais sobre topiramato para o estado de mal epiléptico refratário. Métodos: Foi revisada a literatura para investigar a eficácia do topiramato no tratamento de estado de mal epiléptico refratário. Os termos de busca utilizados foram: "status epilepticus", "refractory", "treatment" e "topiramate". Não se empregaram restrições. Resultados: A busca identificou 487 artigos que descreviam o uso de topiramato para tratamento de estado de mal epiléptico refratário e seus resultados. Relatos de caso, revisões e experimentos em animais foram excluídos. Após exclusão de duplicatas e aplicação dos critérios de inclusão e exclusão, restaram nove estudos. Realizaram-se análises descritivas e qualitativas, com os seguintes resultados: as taxas de resposta, definidas como término de crises até 72 horas após administração de topiramato, variaram entre 27% e 100%. A mortalidade variou de 5,9% a 68%. Desfechos funcionais positivos, definidos como alta hospitalar, volta à funcionalidade basal ou reabilitação, foram documentados por sete estudos, e as taxas variaram entre 4% e 55%. A maioria dos estudos reportou apenas efeitos colaterais leves ou ausentes. Conclusão: Topiramato foi efetivo em abortar estado de mal epiléptico refratário, apresentando baixa mortalidade e boa tolerabilidade. Portanto, topiramato poderia ser uma boa opção como terceira linha para estado de mal epiléptico refratário, porém mais estudos são necessários.


ABSTRACT Objective: To identify current evidence on the use of topiramate for refractory status epilepticus. Methods: We reviewed the literature to investigate the efficacy of topiramate in the treatment of refractory status epilepticus. The search terms used were "status epilepticus", "refractory", "treatment" and "topiramate". No restrictions were used. Results: The search yielded 487 articles that reported using topiramate as a treatment for refractory status epilepticus and its outcomes. Case reports, review articles, and animal experiments were excluded. After excluding duplicates and applying inclusion and exclusion criteria, nine studies were included for analyses. Descriptive and qualitative analyses were performed, and the results were as follows: response rates (defined as termination in-hospital until 72 hours after the administration of topiramate) varied from 27% to 100%. The mortality rate varied from 5.9% to 68%. Positive functional long-term outcomes, defined as discharge, back to baseline or rehabilitation, were documented by seven studies, and the rates ranged between 4% and 55%. Most studies reported no or mild adverse effects. Conclusion: Topiramate was effective in terminating refractory status epilepticus, presented relatively low mortality and was well tolerated. Therefore, topiramate could be a good option as a third-line therapy for refractory status epilepticus, but further studies are necessary.


Subject(s)
Humans , Animals , Status Epilepticus/drug therapy , Anticonvulsants/adverse effects , Topiramate/adverse effects
4.
Article in Chinese | WPRIM | ID: wpr-879860

ABSTRACT

OBJECTIVE@#To systematically evaluate the efficacy and safety of levetiracetam (LEV) versus phenytoin (PHT) as second-line drugs for the treatment of convulsive status epilepticus (CSE) in children.@*METHODS@#English and Chinese electronic databases were searched for the randomized controlled trials comparing the efficacy and safety of LEV and PHT as second-line drugs for the treatment of childhood CSE. RevMan 5.3 software was used for data analysis.@*RESULTS@#Seven studies with 1 434 children were included. The Meta analysis showed that compared with the PHT group, the LEV group achieved a significantly higher control rate of CSE (@*CONCLUSIONS@#LEV has a better clinical effect than PHT in the treatment of children with CSE and does not increase the incidence rate of adverse events.


Subject(s)
Anticonvulsants/adverse effects , Child , Humans , Levetiracetam/therapeutic use , Pharmaceutical Preparations , Phenytoin/adverse effects , Status Epilepticus/drug therapy
5.
Article in English | WPRIM | ID: wpr-888492

ABSTRACT

OBJECTIVES@#To study the effect of gap junction blockers, quinine (QUIN) and carbenoxolone (CBX), on hippocampal ripple energy expression in rats with status epilepticus (SE).@*METHODS@#A total of 24 rats were randomly divided into four groups: model, QUIN, valproic acid (VPA), and CBX (@*RESULTS@#Ripple expression was observed in the hippocampal CA1, CA3, and dentate gyrus regions of normal rats. After 10 minutes of PILO injection, all groups had a gradual increase in mean ripple energy expression compared with 1 day before modeling, with the highest expression level before chloral hydrate injection in the model, VPA and CBX groups (@*CONCLUSIONS@#The change in ripple energy can be used as a quantitative indicator for early warning of seizures, while it cannot predict seizures in the interictal period. Gap junction blockers can reduce ripple energy during seizures.


Subject(s)
Animals , Gap Junctions , Hippocampus , Pilocarpine , Rats , Seizures , Status Epilepticus/drug therapy
6.
Neuroscience Bulletin ; (6): 1427-1440, 2021.
Article in English | WPRIM | ID: wpr-922652

ABSTRACT

Epilepsy is a brain condition characterized by the recurrence of unprovoked seizures. Recent studies have shown that complement component 3 (C3) aggravate the neuronal injury in epilepsy. And our previous studies revealed that TRPV1 (transient receptor potential vanilloid type 1) is involved in epilepsy. Whether complement C3 regulation of neuronal injury is related to the activation of TRPV1 during epilepsy is not fully understood. We found that in a mouse model of status epilepticus (SE), complement C3 derived from astrocytes was increased and aggravated neuronal injury, and that TRPV1-knockout rescued neurons from the injury induced by complement C3. Circular RNAs are abundant in the brain, and the reduction of circRad52 caused by complement C3 promoted the expression of TRPV1 and exacerbated neuronal injury. Mechanistically, disorders of neuron-glia interaction mediated by the C3-TRPV1 signaling pathway may be important for the induction of neuronal injury. This study provides support for the hypothesis that the C3-TRPV1 pathway is involved in the prevention and treatment of neuronal injury and cognitive disorders.


Subject(s)
Animals , Astrocytes/metabolism , Complement C3/metabolism , Epilepsy , Mice , Neurons/pathology , Status Epilepticus , TRPV Cation Channels/metabolism
7.
Repert.Med.Cir ; 30(3): 242-247, 2021. tab.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1363508

ABSTRACT

Introducción: el estado epiléptico (EE) es una afección potencialmente mortal con una morbilidad significativa en quienes sobreviven a esta entidad. Pacientes y métodos: estudio transversal descriptivo de corte analítico con el objetivo de describir la prevalencia y la relación con variables sociodemográficas, electroencefalográficas, imagenológicas y desenlaces clínicos en los pacientes hospitalizados que fueron monitorizado por videoelectroencefalograma (VEEG), en el Hospital de San José de Bogotá, Colombia, entre agosto 2017 y agosto 2019. Resultados: de los 135 pacientes monitorizados por VEEG, 27,47% cumplieron con los criterios para EE. La edad promedio fue 48 (DE: 19,56) años, 54,05% (n=20) de sexo masculino y 75,67% (n=28) sin antecedentes de epilepsia. Predominaron las manifestaciones motoras (70,27%, n=26), en 59,46% en el puntaje STESS fue desfavorable, 64,86% (n=24) requirió inducción a coma y monitorización en la unidad de cuidados intensivos(UCI) y 37,84% (n=14) fallecieron durante su estancia intrahospitalaria. Se encontró una relación entre EE, requerimiento de UCI y muerte intrahospitalaria. Conclusiones: la prevalencia del EE en pacientes hospitalizados monitorizados por VEEG fue cercana a 28%, lo que sugiere una relación entre EE, requerimiento de UCI y muerte intrahospitalaria.


Introduction: status epilepticus (SE) is a life-threatening disorder associated with high morbidity in SE survivors. Patients and methods: descriptive and analytical cross-sectional study with the aim to characterize the prevalence and relation with socio-demographic, electroencephalography and neuro-image variables as well as clinical outcomes of hospitalized patients who received video-electroencephalogram (video-EEG) monitoring, at Hospital de San José in Bogotá, Colombia, between August 2017 and August 2019. Results: of the 135 patients who received video-EEG monitoring, 27.47% met the criteria for SE. The median age was 48 (SD: 19.56) years, 54.05% (n=20) were men and 75.67% (n=28) had no history of epilepsy. There was a predominance of motor manifestations (70.27%, n=26), 59.46% had an unfavorable STESS score, while 64.86% (n=24) required induced coma and monitoring in the intensive care unit (ICU) and 37.84 % (n=14) died during their hospital stay. A relationship was found between SE, requiring admission to the ICU and in-hospital death. Conclusions: the prevalence of SE in hospitalized patients monitored by video-EEG was close to 28%, and a relationship between SE, requiring ICU admission and in-hospital death is suggested.


Subject(s)
Humans , Male , Female , Middle Aged , Seizures , Electroencephalography , Epilepsy , Status Epilepticus , Magnetic Resonance Imaging , Tomography , Monitoring Stations
8.
Med. infant ; 27(2): 133-137, Diciembre 2020. Tab, ilus
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1148492

ABSTRACT

Introducción: Los errores de medicación (EM) causan una elevada morbimortalidad y generan costos innecesarios. El servicio de emergencias (SE) presenta un mayor riesgo de EM que otras áreas. El desarrollo de una herramienta que estandarice el uso de fármacos podría mejorar la seguridad y el proceso de medicación. Objetivos: Evaluar las mejoras en el proceso de medicación mediante el uso de tablas de medicación (TM) durante la atención del estado epiléptico (EE). Materiales y métodos: Se realizó un estudio de tipo antes y después no controlado. La intervención fue el desarrollo e implementación de TM. Se relevó in situ la prescripción, preparación y administración de fármacos incluidos en las TM durante segunda quincena de Octubre y mes de Noviembre 2016, previo a la implementación de la herramienta, y en el mismo período de 2017, luego de la inducción e implementación de las tablas. Se registraron los EM y se categorizaron de acuerdo a la etapa del proceso en que ocurrieron. Resultados: En el período pre-intervención se realizaron 14 registros, 86% (12) tenía al menos un error; 57% (8) errores en la etapa de prescripción, 57% (8) en la de preparación y 21% (3) en la de administración. En el período post-intervención se realizaron 17 registros, 12% (2) tenía por lo menos un EM. No se registraron errores en la fase de prescripción, hubo 12% (2) de errores de preparación y 6% (1) de administración. Conclusión: La implementación de las TM para la estandarización del uso de fármacos en EE resultó una medida muy positiva, mejorando la seguridad en el proceso de medicación (AU)


Introduction: Medication errors (ME) are associated with high morbidity mortality and lead to unnecessary costs. The risk of ME is higher at the emergency department (ED) than in other areas. Developing a tool that standardizes drug use may improve safety and medication processes. Objectives: To evaluate improvements in the medication process by using medication cards (MCs) during status epilepticus (SE) care. Materials and methods: An uncontrolled before-and-after study was conducted. The intervention was the development and implementation of MCs. The in situ prescription, preparation, and administration of drugs included in the MCs was recorded during the second half of October and November 2016, prior to the implementation of the tool, and in the same period of 2017, after the introduction and implementation of the MCs. ME were recorded and categorized according to the stage of the process in which they occurred. Results: In the pre-intervention period 14 episodes were recorded; in 86% (12) at least one error occurred; 57% (8) were ME in the prescription stage, 57% (8) were ME in the preparation stage, and 21% (3) were ME in the administration stage. In the post-intervention period 17 errors were recorded, in 12% (2) at least one ME occurred. No errors were recorded in the prescription stage, 12% (2) were preparation errors, and 6% (1) administration errors. Conclusion: The implementation of MCs for the standardization of medications used in the RU was successful, improving safety in the medication process (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Status Epilepticus/drug therapy , Hospital Rapid Response Team/statistics & numerical data , Medication Errors/prevention & control , Medication Errors/statistics & numerical data , Medication Systems, Hospital/organization & administration , Anticonvulsants/administration & dosage , Quality Improvement , Patient Safety
9.
Arq. neuropsiquiatr ; 78(6): 356-360, June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131711

ABSTRACT

ABSTRACT Background: Generalized periodic discharges (GPDs) are rare patterns that can be found in long-term electroencephalographic monitoring in critical patients. These patterns have been correlated with non-seizure crisis and non-convulsive status epilepticus, associated with poor prognosis. Objective: To compare the outcome between patients who developed GPDs and patients with other abnormalities in long-term electroencephalographic monitoring. Methods: A retrospective study was performed by analyzing the medical records of 112 patients over 18 years who developed GPDs during long-term electroencephalographic monitoring (12‒16 hours of monitoring) in the intensive care unit of a general hospital, compared with a group that had only nonspecific abnormalities in the monitoring. Results: Age and cardiorespiratory arrest (CA) were risk factors for death - OR 1.04 (95% CI 1,02 - 1,07) and p<0.001; OR 3.00 (95% CI 1,01 - 8,92) and p=0.046, respectively. It was not possible to evaluate if GPDs alone were associated with an unfavorable outcome or would be a bias for the development of CA in these patients. However, of the six isolated GPDs cases, 2/3 evolved to death, showing a tendency to worse prognosis. A significant difference (p=0.031) was observed for a worse outcome when comparing the group of 28 patients who presented GPD or CA with the other group which did not present any of these variables; of these 28 patients, 20 (71.4%) died. Conclusions: The presence of post-CA GPDs was associated with worse prognosis, but it was not clear whether these patterns are independent factors of an unfavorable evolution.


RESUMO Introdução: As descargas periódicas generalizadas (DPG) são padrões raros que podem ser encontrados durante monitorização eletroencefalográfica prolongada (MEP) em pacientes críticos. Esses padrões têm sido correlacionados com crises não convulsivas e estado de mal epiléptico não convulsivo, associados a um pior prognóstico. Objetivo: Comparar o desfecho entre pacientes que desenvolveram DPG e pacientes com anormalidades inespecíficas na MEP. Métodos: Foi realizado um estudo retrospectivo através da análise dos prontuários de 112 pacientes acima de 18 anos que desenvolveram DPG durante MEP (de 12‒16 horas de monitorização) na unidade de terapia intensiva de um hospital geral, comparando com um grupo que apresentou apenas anormalidades inespecíficas na MEP. Resultados: As variáveis idade e parada cardiorrespiratória (PCR) se mostraram como fatores de risco estatisticamente significativos para óbito - OR 1,04 (IC 95% 1,02 - 1,07) e p<0,001; OR 3,00 (IC 95% 1,01 - 8,92) e p=0,046, respectivamente. Não foi possível avaliar se DPG isoladamente se associaram a um desfecho desfavorável ou seriam um viés para o desenvolvimento de PCR nesses pacientes. Porém, dos seis casos de DPG isoladas, 2/3 evoluíram para óbito, o que revela uma tendência a pior prognóstico. Foi observada diferença significativa (p=0,031) para pior desfecho ao comparar o grupo de 28 pacientes que apresentou DPG ou PCR com o outro grupo que não apresentou nenhuma dessas variáveis, sendo que desses 28 pacientes, 20 (71,4%) foram a óbito. Conclusões: A presença de DPG pós-PCR está associada a pior prognóstico, porém não ficou claro se esses padrões são fatores independentes de evolução desfavorável.


Subject(s)
Humans , Patient Discharge , Status Epilepticus , Retrospective Studies , Hospital Mortality , Electroencephalography/methods
10.
Article in English | WPRIM | ID: wpr-787136

ABSTRACT

Regulator of calcineurin 1 (RCAN1) can be induced by an intracellular calcium increase and oxidative stress, which are characteristic features of temporal lobe epilepsy. Thus, we investigated the spatiotemporal expression and cellular localization of RCAN1 protein and mRNA in the mouse hippocampus after pilocarpine-induced status epilepticus (SE). Male C57BL/6 mice were given pilocarpine hydrochloride (280 mg/kg, i.p.) and allowed to develop 2 h of SE. Then the animals were given diazepam (10 mg/kg, i.p.) to stop the seizures and sacrificed at 1, 3, 7, 14, or 28 day after SE. Cresyl violet staining showed that pilocarpine-induced SE resulted in cell death in the CA1 and CA3 subfields of the hippocampus from 3 day after SE. RCAN1 immunoreactivity showed that RCAN1 was mainly expressed in neurons in the shammanipulated hippocampi. At 1 day after SE, RCAN1 expression became detected in hippocampal neuropils. However, RCAN1 signals were markedly enhanced in cells with stellate morphology at 3 and 7 day after SE, which were confirmed to be reactive astrocytes, but not microglia by double immunofluorescence. In addition, real-time reverse transcriptase–polymerase chain reaction showed a significant upregulation of RCAN1 isoform 4 (RCAN1-4) mRNA in the SE-induced hippocampi. Finally, in situ hybridization with immunohistochemistry revealed astrocytic expression of RCAN1-4 after SE. These results demonstrate astrocytic upregulation of RCAN1 and RCAN1-4 in the mouse hippocampus in the acute and subacute phases of epileptogenesis, providing foundational information for the potential role of RCAN1 in reactive astrocytes during epileptogenesis.


Subject(s)
Animals , Astrocytes , Calcineurin , Calcium , Cell Death , Diazepam , Epilepsy , Epilepsy, Temporal Lobe , Fluorescent Antibody Technique , Hippocampus , Humans , Immunohistochemistry , In Situ Hybridization , Male , Mice , Microglia , Neurons , Neuropil , Oxidative Stress , Pilocarpine , RNA, Messenger , Seizures , Status Epilepticus , Up-Regulation , Viola
11.
Med. infant ; 26(3): 267-271, sept. 2019. Tab
Article in Spanish | LILACS | ID: biblio-1023724

ABSTRACT

Introducción: El estado epiléptico (EE) es la emergencia neurológica más frecuente en pediatría. Los pacientes que no responden al tratamiento estándar con dosis adecuadas de benzodiacepinas seguido de una droga antiepiléptica aceptable son definidos como Estado epiléptico Refractario (ER). Objetivo: caracterizar la población de niños con EE que ingresan a UCIP y determinar qué factores son predictores de refractariedad en esta población. Métodos: Estudio de casos y controles, retrospectivo. Población: niños con EE internados en UCIP desde Febrero 2015 a Febrero 2017. Casos: Estado epiléptico Refractario (ER). Controles: Estado epiléptico No Refractario (ENR). Se calculó el Odds Ratio (OR) individual para las distintas variables en Med Calc. Resultados: Se internaron 35 pacientes de los cuales 12 fueron casos y 23 controles. Hubo fiebre en 77% de los pacientes. En el total de niños estudiados hubo 11% con antecedente de convulsión febril, 11% con antecedente de epilepsia y 9% con antecedente de malformación del SNC. Los niños con antecedente de convulsión febril tuvieron 2,5 veces mayor riesgo de ER (OR: 2,58; IC 95%: 1,17-5,68). Los niños con EE que tenían antecedentes de enfermedad neurológica previa presentaron riesgo de ER 2,6 veces mayor que el grupo control (OR 2,60; IC 95%: 1,24-5,42). Discusión: Dado el aumento en la mortalidad de los pacientes con ER sería importante disponer de más herramientas para predecir este desenlace e iniciar tratamiento oportuno. Resultaría útil entrenar a los padres de niños con antecedente de convulsión febril en la aplicación de medicación antiepiléptica prehospitalaria, esto podría prevenir la farmacorresistencia, el daño neurológico y las complicaciones que acarrea el ingreso a UCIP. (AU)


Introduction: Status epilepticus (SE) is the most common neurologic emergency in children. Patients that do not respond to standard treatment with adequate doses of benzodiazepines followed by an acceptable antiepileptic drug are defined as having refractory status epilepticus (RSE). Objective: To characterize the population of children with SE admitted to the PICU and to determine predictive factors for refractoriness in this population. Methods: A retrospective case-control study was conducted. Population: Children with SE admitted to the PICU between February 2015 and February 2017. Cases: Refractory status pilepticus (RSE). Controls: Non-refractory status epilepticus (NRSE). Individual Odds Ratio (OR) was calculated for different variables using Med Calc. Results: 35 patients were admitted of whom 12 were cases and 23 controls. Overall, 77% of the patients had fever. Of all the children, 11% had a history of febrile seizures, 11% had history of epilepsy and 9% had a CNS malformation. Children with a history of febrile seizures had a 2.5-fold higher risk of developing RSE (OR: 2.58; 95% CI: 1.17-5.68). Children with SE that had a history of neurologic disease had a 2.6-fold higher risk of developing RSE than controls (OR 2.60; 95% CI: 1.24-5.42). Discussion: Given the increased mortality in children with RSE, availability of tools to predict this outcome in order to initiate early treatment is important. It would be useful to train the parents of children with a history of febrile seizures in the prehospital administration of antiepileptic drugs as this may prevent pharmaco-resistance, neurologic damage, and complication related to PICU admission (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Status Epilepticus/complications , Status Epilepticus/etiology , Status Epilepticus/drug therapy , Drug Resistance , Intensive Care Units, Pediatric , Seizures, Febrile/drug therapy , Drug Resistant Epilepsy/therapy , Anticonvulsants/therapeutic use , Case-Control Studies , Retrospective Studies
12.
Medicina (B.Aires) ; 79(supl.3): 48-53, set. 2019. tab
Article in Spanish | LILACS | ID: biblio-1040550

ABSTRACT

Los fármacos antiepilépticos constituyen el tratamiento inicial en pacientes con epilepsia. Los antIepilépticos producidos después del año 2000 se conocen como fármacos de tercera generación. Estas drogas ofrecen nuevos mecanismos de acción y una farmacocinética más favorable, minimizando efectos adversos o interacciones medicamentosas. Las drogas de amplio espectro como brivaracetam y clobazam son una buena opción en casos de crisis generalizadas y poseen un grado de tolerabilidad muy aceptable. Los nuevos antiepilépticos bloqueadores de canales de sodio, como lacosamida y eslicarbazepina tienen un perfil de efectos adversos más favorable que los bloqueadores de sodio de primera o segunda generación. Estos nuevos medicamentos pueden utilizarse en pacientes con epilepsia de difícil control. Cannabidiol y fenfluramina son muy útiles en el tratamiento del síndrome de Dravet o Lennox Gastaut. La Alopregnenolona y ganaxolona demuestran buena eficacia en casos de estado epiléptico y podrían en el futuro cercano tener un papel importante en este escenario clínico.


Antiepileptic drugs are the first treatment option in patients with epilepsy. Drugs developed after 2000 are known as third generation antiepileptic drugs. These medications offer new mechanisms of action and favorable pharmacokinetics, decreasing the occurrence of side effects and drug-drug interactions. Broad spectrum antiepileptic drugs, such as brivaracetam and clobazam are good choices for generalized tonic colonic seizures and are well tolerated.New sodium channel blockers such as lacosamide and eslicarbazepine, have a more "benign" side effect profile than the first or second generation of sodium channel blockers. These new drugs are useful therapies in patients with epilepsy of difficult control. Cannabidiol and fenfluramine are useful in the treatment of Dravet or Lennox Gastaut syndrome. Allopregnenolona and ganaxolone showed good efficacy in status epilepticus and could play an important future role in this clinical scenario.


Subject(s)
Humans , Epilepsy/drug therapy , Anticonvulsants/therapeutic use , Anticonvulsants/pharmacology , Status Epilepticus/drug therapy , Drug Interactions , Anticonvulsants/classification
14.
Article in Korean | WPRIM | ID: wpr-766817

ABSTRACT

Extrapontine myelinolysis is a demyelinating disorder usually caused by rapid correction of chronic hyponatremia. We present an 82-year-old female patient with general weakness, and severe hyponatremia (103 mEq/L) which was corrected 14 mEq/L during 21 hours. She was stuporous and presented status epilepticus. Brain T2-weighted image showed high signal intensities of bilateral thalami and electroencephalogram monitoring indicated right hemisphere lateralized periodic discharges, maximal in the right frontal region. This case shows that status epilepticus can occur in a patient of extrapontine myelinolysis involved bilateral thalami without pontine lesions.


Subject(s)
Aged, 80 and over , Brain , Demyelinating Diseases , Electroencephalography , Female , Humans , Hyponatremia , Myelinolysis, Central Pontine , Status Epilepticus , Stupor
15.
Article in Korean | WPRIM | ID: wpr-766816

ABSTRACT

Diagnosis of transient ischemic attack has been entirely dependent on the clinical history due to the absence of brain magnetic resonance imaging lesion. It is challenging to distinguish between transient ischemic attack and transient ischemic attack-mimics. Cerebral microbleeds would be found in 11.1–23.5% of incidental findings in elderly population. However, cerebral microbleeds have been known to lead to cognitive decline, dementia, seizure and even status epilepticus. We report a case of cerebral microbleeds induced epileptic seizure, visiting the emergency room with sudden onset unilateral motor weakness.


Subject(s)
Aged , Brain , Dementia , Diagnosis , Emergency Service, Hospital , Epilepsy , Humans , Incidental Findings , Ischemic Attack, Transient , Magnetic Resonance Imaging , Seizures , Status Epilepticus
16.
Article in English | WPRIM | ID: wpr-765925

ABSTRACT

Generalized periodic discharges (GPDs) with triphasic morphology are an electroencephalographic (EEG) pattern traditionally associated with encephalopathy and coma, although they have been observed in a wide array of neurological disorders. The clinical significance of these waveforms and their relationship to seizures and prognosis has been debated, and differentiation between interictal patterns, patterns associated with seizures, and patterns representing nonconvulsive status epilepticus can at times be a challenge. The most established literature suggests that GPDs, including those with triphasic morphology, are associated with the development of electrographic seizures, but that in the absence of clinical information, distinguishing waveforms based on morphology alone may not be clinically useful. Recent work has advocated for a more proactive approach in evaluating GPDs with triphasic morphology. Further studies of nonsedating antiseizure drugs in patients with GPDs with triphasic morphology that incorporate continuous EEG monitoring will be useful in tailoring therapy to optimize long-term clinical outcomes and recovery.


Subject(s)
Brain Diseases , Coma , Electroencephalography , Humans , Nervous System Diseases , Prognosis , Seizures , Status Epilepticus
17.
Article in English | WPRIM | ID: wpr-765919

ABSTRACT

BACKGROUND: Cerebral air embolism is uncommon but potentially causes catastrophic events such as cardiac damage or even death. However, due to a low overall incidence, it may go undiagnosed. CASE REPORT: A 56-year-old man with a medical history of right upper lobectomy due to lung cancer showed changes in mental status after the Valsalva maneuver, followed by status epilepticus during admission. Brain and chest computed tomography showed cerebral air embolism and accidental pneumothorax in the right major fissure. After antiepileptic drug infusion and oxygen therapy, he recovered completely. CONCLUSION: Since cerebral air embolism may result in fatal outcomes, it should be suspected in patients with sudden neurological deterioration after routine medical procedures.


Subject(s)
Brain , Embolism, Air , Fatal Outcome , Humans , Incidence , Lung Neoplasms , Middle Aged , Oxygen , Pneumothorax , Status Epilepticus , Thorax , Valsalva Maneuver
18.
Article in Chinese | WPRIM | ID: wpr-774073

ABSTRACT

OBJECTIVE@#To study the clinical features of electrical status epilepticus during sleep (ESES) in children, as well as the clinical effect of methylprednisolone pulse therapy in children with ESES.@*METHODS@#A retrospective analysis was performed using the clinical data of 78 children with ESES. Among these children, 56 children who had had the failure of antiepileptic drugs were treated with methylprednisolone pulse therapy at a dose of 15-20 mg/(kg·d) for three courses. Each course of treatment was 3 days, followed by oral prednisone [1-2 mg/(kg·d)] for 3 days. The role of methylprednisolone pulse therapy in eliminating ESES, controlling clinical seizures, and improving intelligence and behaviors was analyzed.@*RESULTS@#The mean age of onset of epilepsy in 78 children was 6.8±2.4 years, and the mean age for the first occurrence of ESES was 7.6±2.5 years. Compared with normal children, children with ESES had delayed intelligence development and higher scores of some behavior problems. Methylprednisolone pulse therapy had an overall response rate of 73% (41/56) on clinical seizures, and the overall response rate on electroencephalography (EEG)/spike-wave index was 70% (39/56) after treatment. There were significant improvements in verbal intelligence quotient, performance intelligence quotient and full intelligence quotient, and significant reductions in the scores of learning problems, impulse-hyperactivity and hyperactivity index after treatment (P<0.05). The overall recurrence rate after 1-year follow-up was 29% (11/38).@*CONCLUSIONS@#ESES often presents around school age and impairs children's intelligence and behaviors. Methylprednisolone pulse therapy has a marked efficiency in reducing clinical seizures and EEG discharges in children with ESES and can improve intelligence and behavior development, but the recurrence rate remains high.


Subject(s)
Anticonvulsants , Child , Child, Preschool , Electroencephalography , Follow-Up Studies , Humans , Methylprednisolone , Therapeutic Uses , Retrospective Studies , Sleep , Status Epilepticus , Drug Therapy
19.
Article in English | WPRIM | ID: wpr-761788

ABSTRACT

Vascular endothelial growth factor (VEGF)-C and its receptor, vascular endothelial growth factor receptor (VEGFR)-3, are responsible for lymphangiogenesis in both embryos and adults. In epilepsy, the expression of VEGF-C and VEGFR-3 was significantly upregulated in the human brains affected with temporal lobe epilepsy. Moreover, pharmacologic inhibition of VEGF receptors after acute seizures could suppress the generation of spontaneous recurrent seizures, suggesting a critical role of VEGF-related signaling in epilepsy. Therefore, in the present study, the spatiotemporal expression of VEGF-C and VEGFR-3 against pilocarpine-induced status epilepticus (SE) was investigated in C57BL/6N mice using immunohistochemistry. At 1 day after SE, hippocampal astrocytes and microglia were activated. Pyramidal neuronal death was observed at 4 days after SE. In the subpyramidal zone, VEGF-C expression gradually increased and peaked at 7 days after SE, while VEGFR-3 was significantly upregulated at 4 days after SE and began to decrease at 7 days after SE. Most VEGF-C/VEGFR-3-expressing cells were pyramidal neurons, but VEGF-C was also observed in some astrocytes in sham-manipulated animals. However, at 4 days and 7 days after SE, both VEGFR-3 and VEGF-C immunoreactivities were observed mainly in astrocytes and in some microglia of the stratum radiatum and lacunosum-moleculare of the hippocampus, respectively. These data indicate that VEGF-C and VEGFR-3 can be upregulated in hippocampal astrocytes and microglia after pilocarpine-induced SE, providing basic information about VEGF-C and VEGFR-3 expression patterns following acute seizures.


Subject(s)
Adult , Animals , Astrocytes , Brain , Embryonic Structures , Epilepsy , Epilepsy, Temporal Lobe , Hippocampus , Humans , Immunohistochemistry , Lymphangiogenesis , Mice , Microglia , Pyramidal Cells , Receptors, Vascular Endothelial Growth Factor , Seizures , Status Epilepticus , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth Factor C , Vascular Endothelial Growth Factor Receptor-3
20.
Article in English | WPRIM | ID: wpr-764371

ABSTRACT

BACKGROUND AND PURPOSE: There is sparsity of quality evidence for the use of drugs after first-line benzodiazepines in convulsive status epilepticus in children. The aim of the study was to compare the clinical efficacy and safety of intravenous levetiracetam versus intravenous phenytoin as second-line drugs in the management of generalized convulsive status epilepticus in children. METHODS: This open-label randomized controlled trial was conducted in the Emergency Department of The Children's Hospital and The Institute of Child Health, Multan, Pakistan over a period of 4 years and 6 months from January 2014 to June 2018. This study included 600 children with generalized convulsive status epilepticus: 300 in the 40 mg/kg levetiracetam group, and 300 in the 20 mg/kg phenytoin group. Cessation of a clinical seizure (seizure cessation rate) within 30 minutes after the end of drug administration was the primary outcome in this study, and the presence or absence of adverse effects was noted as the secondary outcome. Data were analyzed using SPSS (version 20.0). RESULTS: The children in the levetiracetam and phenytoin were aged 3.5±0.2 and 3.4±0.2 years (mean±SD), respectively, their seizure durations before the start of treatment were 25.1±0.6 and 23.8±0.4 minutes, and their treatment efficacies were 278/300 (92.7%) and 259/300 (83.3%). Levetiracetam was significantly more effective than phenytoin (p=0.012), with no significant difference in safety. Adverse events were observed in eight children in the phenytoin group. CONCLUSIONS: Levetiracetam is significantly more effective than phenytoin for the treatment of convulsive status epilepticus in children who have failed to respond to benzodiazepines.


Subject(s)
Benzodiazepines , Child Health , Child , Emergency Service, Hospital , Humans , Pakistan , Phenytoin , Seizures , Status Epilepticus , Treatment Outcome
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