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1.
Am J Emerg Med ; 54: 328.e1-328.e2, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1514111

ABSTRACT

BACKGROUND: Status Epilepticus is the most common non-traumatic neurologic emergency in childhood. Current algorithms prioritize the use of benzodiazepines as first line treatment followed by Levetiracetam or Valproic Acid, possibly Fosphenytoin and eventually high dose Propofol and intubation. CASE REPORT: A 9-month old girl was brought to the emergency department with a continuous seizure involving the right upper and lower extremity for 45 min prior to arrival. Patient received a dose of rectal Diazepam, intramuscular Midazolam, 2 doses of Lorazepam, Levetiracetam, Fosphenytoin and 2 additional doses of Lorazepam. The seizure remained refractory and generalized. In anticipation of intubation, and because of its action on the NMDA receptor, Ketamine (1 mg/kg IV) was administered. The clonic movements and eye deviations stopped. Patient was intubated for airway protection, sedated with Propofol, then admitted to the PICU. EEG showed no evidence of a seizure pattern. Labs (CBC, CMP, COVID) were unremarkable except for WBC 24.5, blood glucose of 346 and CO2 of 17 with normal anion gap. Urinalysis showed a urinary tract infection. Patient was at her baseline on 1 week post-discharge re-evaluation. Ketamine theoretically may abort seizures through blockade of NMDA receptors which are unregulated in status epilepticus. To date, no randomized controlled trials have been reported. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ketamine may have a role in treating status epilepticus. It may be considered for induction for rapid sequence intubation and possibly as a third or fourth line agent in refractory cases.


Subject(s)
COVID-19 , Ketamine , Propofol , Status Epilepticus , Aftercare , Anticonvulsants/therapeutic use , Female , Humans , Infant , Ketamine/adverse effects , Levetiracetam , Lorazepam/therapeutic use , Patient Discharge , Propofol/therapeutic use , Seizures/drug therapy , Status Epilepticus/drug therapy
3.
Neurol Sci ; 42(7): 2611-2614, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1188106

ABSTRACT

Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.


Subject(s)
COVID-19 , Status Epilepticus , Aged , Humans , Male , RNA , SARS-CoV-2 , Seizures/complications , Seizures/diagnostic imaging , Seizures/drug therapy , Status Epilepticus/complications , Status Epilepticus/diagnostic imaging , Status Epilepticus/drug therapy
4.
J Neurol ; 268(10): 3569-3573, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1130772

ABSTRACT

Neurological manifestations may be common in COVID-19 patients. They may include several syndromes, such as a suggested autoimmune abnormal response, which may result in encephalitis and new-onset refractory status epilepticus (NORSE). Quickly recognizing such cases and starting the most appropriate therapy is mandatory due to the related rapid worsening and bad outcomes. This case series describes two adult patients admitted to the university hospital and positive to novel coronavirus 2019 (SARS-CoV-2) infection who developed drug-resistant status epilepticus. Both patients underwent early electroencephalography (EEG) assessment, which showed a pathological EEG pattern characterized by general slowing, rhythmic activity and continuous epileptic paroxysmal activity. A suspected autoimmune etiology, potentially triggered by SARS-CoV-2 infection, encouraged a rapid work-up for a possible autoimmune encephalitis diagnosis. Therapeutic approach included the administration of 0.4 g/kg intravenous immunoglobulin, which resulted in a complete resolution of seizures after 5 and after 10 days, respectively, without adverse effects and followed by a normalization of the EEG patterns.


Subject(s)
COVID-19 , Status Epilepticus , Adult , Electroencephalography , Humans , Immunoglobulins, Intravenous/therapeutic use , SARS-CoV-2 , Seizures , Status Epilepticus/drug therapy
5.
Epilepsy Behav ; 112: 107375, 2020 11.
Article in English | MEDLINE | ID: covidwho-728889

ABSTRACT

During epidemic outbreaks, epilepsy course can be modified by different physical and psychological stressors and, most importantly, by irregular therapy intake. The effect of COVID-19 and quarantine isolation on the course of epilepsy and on incidence of new-onset seizures is still unclear. With the aim of managing epilepsy in quarantined patients, three Italian Epilepsy Centers set up telephone consultations using a semistructured interview, allowing a prospective collection of data on seizure course and other seizure-related problems during pandemic. The collected data on seizure course were compared with the analogous period of 2019. The level of patients' concern relating to the COVID-19 pandemic was also assessed using a numeric rating scale. To address the effect of COVID-19 pandemic on seizure incidence, data collection included the number of consultations for first seizures, relapse seizures, and status epilepticus (SE) in the emergency department of one of the participating centers. Clinical telephone interviews suggest the absence of quarantine effect on epilepsy course in our cohort. No differences in incidence of emergency consultations for seizures over a two-month period were also observed compared with a control period. As demonstrated in other infective outbreaks, good antiepileptic drug (AED) supplying, precise information, and reassurance are the most important factors in chronic conditions to minimize psychological and physical stress, and to avoid unplanned treatment interruptions.


Subject(s)
Anticonvulsants/therapeutic use , Coronavirus Infections , Epilepsy/drug therapy , Pandemics , Pneumonia, Viral , Seizures/epidemiology , Telemedicine , Adult , Anticonvulsants/supply & distribution , Betacoronavirus , COVID-19 , Cohort Studies , Female , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Prevalence , Prospective Studies , Recurrence , Referral and Consultation , SARS-CoV-2 , Seizures/drug therapy , Status Epilepticus/drug therapy , Status Epilepticus/epidemiology
7.
Ann Clin Transl Neurol ; 7(7): 1240-1244, 2020 07.
Article in English | MEDLINE | ID: covidwho-260391

ABSTRACT

Neurological complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. We present a single-center retrospective case series reporting the EEG and outcome of de novo status epilepticus (SE) in two African-American women with laboratory-confirmed SARS-CoV-2 virus. SE was the initial presentation in one asymptomatic individual. Patient 2 had COVID-19 pneumonia, and fluctuating mental status that raised the suspicion of subclinical SE. The patient with older age and higher comorbidities failed to recover from the viral illness that has no definitive treatment.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Status Epilepticus/etiology , African Americans , Aged , Anticonvulsants/therapeutic use , Betacoronavirus , COVID-19 , Electroencephalography , Female , Humans , Levetiracetam/therapeutic use , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2 , Status Epilepticus/diagnosis , Status Epilepticus/drug therapy
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