The treatment of super-refractory status epilepticus: a critical review of available therapies and a clinical treatment protocol
Simon Shorvon,Monica Ferlisi +1 more
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TLDR
There is an urgent need for the establishment of a database of outcomes of individual therapies for super-refractory status epilepticus, which is an uncommon but important clinical problem with high mortality and morbidity rates.Abstract:
Super-refractory status epilepticus is defined as status epilepticus that continues or recurs 24 h or more after the onset of anaesthetic therapy, including those cases where status epilepticus recurs on the reduction or withdrawal of anaesthesia. It is an uncommon but important clinical problem with high mortality and morbidity rates. This article reviews the treatment approaches. There are no controlled or randomized studies, and so therapy has to be based on clinical reports and opinion. The published world literature on the following treatments was critically evaluated: anaesthetic agents, anti-epileptic drugs, magnesium infusion, pyridoxine, steroids and immunotherapy, ketogenic diet, hypothermia, emergency resective neurosurgery and multiple subpial transection, transcranial magnetic stimulation, vagal nerve stimulation, deep brain stimulation, electroconvulsive therapy, drainage of the cerebrospinal fluid and other older drug therapies. The importance of treating the identifying cause is stressed. A protocol and flowchart for managing super-refractory status epilepticus is suggested. In view of the small number of published reports, there is an urgent need for the establishment of a database of outcomes of individual therapies.read more
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Antagomirs targeting microRNA-134 increase hippocampal pyramidal neuron spine volume in vivo and protect against pilocarpine-induced status epilepticus
Eva M. Jimenez-Mateos,Tobias Engel,Paula Merino-Serrais,Isabel Fernaud-Espinosa,Natalia Rodriguez-Alvarez,James P. Reynolds,Cristina R. Reschke,Ronan M. Conroy,Ross C. McKiernan,Javier DeFelipe,David C. Henshall +10 more
TL;DR: In vivo evidence that microRNA-134 regulates spine volume in the hippocampus is provided and validation of the seizure-suppressive effects of miR-134 antagomirs in a model with a different triggering mechanism is validated, indicating broad conservation of anticonvulsant effects.
Journal ArticleDOI
Refractory and super‐refractory status epilepticus in adults: a 9‐year cohort study
TL;DR: This work describes RSE and SRSE frequencies and identifies associated clinical variables in status epilepticus continuing after general anaesthesia and describes the prevalence and related clinical profiles of these patients.
Journal ArticleDOI
Incidence and mortality of super-refractory status epilepticus in adults
Anne-Mari Kantanen,Matti Reinikainen,Ilkka Parviainen,Esko Ruokonen,Marika Ala-Peijari,Tom Bäcklund,Juha Koskenkari,Ruut Laitio,Reetta Kälviäinen +8 more
TL;DR: The mortality of patients with SRSE, 36%, was comparable to earlier studies and twofold higher than the mortality of Patients with RSE, and approximately 20% of patients treated in Finnish ICUs progressed to having SRSE.
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Management of generalised convulsive status epilepticus (SE): A prospective randomised controlled study of combined treatment with intravenous lorazepam with either phenytoin, sodium valproate or levetiracetam – Pilot study
Ravindranadh Chowdary Mundlamuri,S Sinha,D.K. Subbakrishna,Parthipulli Vasuki Prathyusha,Madhu Nagappa,Parayil Sankaran Bindu,A B Taly,G.S. Umamaheswara Rao,Parthasarthy Satishchandra +8 more
TL;DR: Phenytoin, valproate, and levetiracetam are safe and equally efficacious following lorazepam in GCSE and the choice of AEDs could be individualised based on co-morbidities.
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Immunity and inflammation in status epilepticus and its sequelae: possibilities for therapeutic application
TL;DR: 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.
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Refractory Status Epilepticus: Frequency, Risk Factors, and Impact on Outcome
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