Evolving Concepts of Nonconvulsive Status Epilepticus

Drislane, Frank W.

doi:10.1007/978-3-319-58200-9_19

Cited by 2 publications

(2 citation statements)

References 95 publications

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“…Over the last two decades, however, increasing numbers of cases of NCSE are not of these ‘classic‘ types, but rather related to acute and serious medical, neurologic, or traumatic illnesses -- occasionally superimposed upon epilepsy syndromes but more often arising anew during an acute illness. For this “non–classic” NCSE (Drislane, 2018), ILAE definitions could not assign a definite ‘t1’ or ‘t2’ specifying the urgency of treatment. They are likely the most common types of NCSE found by continuous EEG monitoring (C-EEG) in ICUs -- and include many or most of the cases Drs Rossetti and Hirsch covered in their discussions.…”

Section: Dr Frank W Drislane’s Commentsmentioning

confidence: 99%

Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate

Rossetti

Hirsch

Drislane

2019

Clinical Neurophysiology Practice

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Section: Dr Frank W Drislane’s Commentsmentioning

confidence: 99%

Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate

Rossetti

Hirsch

Drislane

2019

Clinical Neurophysiology Practice

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“…Absence SE and similar generalized forms of NCSE on the one hand, and CPSE or focal-onset NCSE on the other, constitute the Bclassic^types of NCSE. Most cases of ongoing NCSE diagnosed in ICUs currently, however, are not of these classic types but are rather related to acute medical, neurologic, or traumatic illnesses, sometimes superimposed upon epilepsy syndromes but more often arising anew during the acute illness [117]. Many generalized NCSE syndromes are secondarily generalized (with underlying and sometimes severe lesions) or the result of systemic or metabolic derangements.…”

Section: The Problem Of Bnon-classical^ncsementioning

confidence: 99%

Treatment of Refractory and Super-refractory Status Epilepticus

Rai

Drislane

2018

Neurotherapeutics

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Refractory and super-refractory status epilepticus (SE) are serious illnesses with a high risk of morbidity and even fatality. In the setting of refractory generalized convulsive SE (GCSE), there is ample justification to use continuous infusions of highly sedating medications-usually midazolam, pentobarbital, or propofol. Each of these medications has advantages and disadvantages, and the particulars of their use remain controversial. Continuous EEG monitoring is crucial in guiding the management of these critically ill patients: in diagnosis, in detecting relapse, and in adjusting medications. Forms of SE other than GCSE (and its continuation in a "subtle" or nonconvulsive form) should usually be treated far less aggressively, often with nonsedating anti-seizure drugs (ASDs). Management of "non-classic" NCSE in ICUs is very complicated and controversial, and some cases may require aggressive treatment. One of the largest problems in refractory SE (RSE) treatment is withdrawing coma-inducing drugs, as the prolonged ICU courses they prompt often lead to additional complications. In drug withdrawal after control of convulsive SE, nonsedating ASDs can assist; medical management is crucial; and some brief seizures may have to be tolerated. For the most refractory of cases, immunotherapy, ketamine, ketogenic diet, and focal surgery are among several newer or less standard treatments that can be considered. The morbidity and mortality of RSE is substantial, but many patients survive and even return to normal function, so RSE should be treated promptly and as aggressively as the individual patient and type of SE indicate.

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Evolving Concepts of Nonconvulsive Status Epilepticus

Cited by 2 publications

References 95 publications

Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate

Nonconvulsive seizures and nonconvulsive status epilepticus in the neuro ICU should or should not be treated aggressively: A debate

Treatment of Refractory and Super-refractory Status Epilepticus

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