No abstract

Epileptic seizures are self-limited, lasting, in general, less than to 2 minutes. Status epilepticus (SE) is manifested by continuous or recurrent epileptic seizures without full recovery of motor, sensory and/or cognitive functions, and has multiple etiologies and a diverse prognosis. The duration of seizures in SE varies from 5 to 30 minutes, depending on the definition 1 . It is one of the most frequent neurological emergencies, with an estimated annual incidence of from 6.2 to 61/100,000 people 2,3 . SE is associated with long-term mortality that is nearly three times greater than that of the general population 4 . Indeed, despite new advances in medical treatment, short-term mortality remains high, ranging from 3 to 40%, depending on the sampling methods, age, specific etiology, or refractoriness of SE .Several studies agree that the most important factors related to mortality in SE are older age, acute symptomatic etiology such as central nervous system (CNS) infection, acute stroke, metabolic disturbances, and anoxia, and long seizure duration. Anti-epileptic drug (AED) withdrawal in previously epileptic patients is typically associated with low mortality 2,6 . For other characteristics, such as gender, history of prior epilepsy, refractory SE, adequacy of medical treatment, presence of medical complications, level of consciousness, and electroencephalographic pattern, there is no consensus in the literature 2 . A better understanding of SE prognostic factors would assist in making treatment-related decisions. AbStrActObjective: Status epilepticus (SE) is associated with significant morbidity and mortality, and there is some controversy concerning predictive indicators of outcome. Our main goal was to determine mortality and to identify factors associated with SE prognosis. Method: This prospective study in a tertiary-care university hospital, included 105 patients with epileptic seizures lasting more than 30 minutes. Mortality was defined as death during hospital admission. Results: The case-fatality rate was 36.2%, which was higher than in previous studies. In univariate analysis, mortality was associated with age, previous epilepsy, complex focal seizures; etiology, recurrence, and refractoriness of SE; clinical complications, and focal SE. In multivariate analysis, mortality was associated only with presence of clinical complications. Conclusions: Mortality associated with SE was higher than reported in previous studies, and was not related to age, specific etiology, or SE duration. In multivariate analysis, mortality was independently related to occurrence of medical complications.Keywords: status epilepticus, epilepsy, mortality, prognosis. reSumo Objetivos: Status epilepticus (SE) está associado com morbidade e mortalidade importantes. Diversos estudos avaliaram determinantes de prognóstico relacionados com SE, havendo controvérsias neste sentido. O objetivo deste estudo foi avaliar mortalidade no SE e seus fatores determinantes. Método: Estudo prospectivo, em Ribeirão Preto, incluiu 105 pacientes...

Este artigo relata as conclusões da reunião de consenso da Associação Brasileira de Sono com médicos especialistas brasileiros sobre o tratamento da narcolepsia, baseado na revisão dos artigos sobre narcolepsia publicados entre 1980 e 2010. Os objetivos do consenso são valorizar o uso de agentes avaliados em estudos randomizados placebo-controlados, emitir recomendações de consenso para o uso de outras medicações e informar pontos importantes a respeito da segurança e efeitos adversos das medicações. O tratamento da narcolepsia é baseado em diversas classes de agentes, estimulantes para sonolência excessiva, agentes antidepressivos para cataplexia e hipnóticos para sono noturno fragmentado. Medidas comportamentais são igualmente importantes e recomendadas universalmente. Todos os ensaios clínicos terapêuticos foram classificados de acordo com o nível de qualidade da evidência. Recomendações terapêuticas individualizadas para cada tipo de sintoma e recomendações gerais foram formuladas pelos autores. Modafinila é indicada como a primeira escolha para o tratamento da sonolência diurna. Agentes de segunda escolha para o tratamento da sonolência excessiva são metilfenidato de liberação lenta seguido pelo mazindol. Reboxetina, clomipramina, venlafaxina, desvenlafaxina e os inibidores seletivos de recaptação de serotonina em doses altas são a primeira escolha para o tratamento da cataplexia. Hipnóticos são utilizados para o tratamento do sono noturno fragmentado. Antidepressivos e hipnóticos são igualmente utilizados para o tratamento das alucinações hipnagógicas e paralisia do sono.