Neuromodulation in new-onset refractory status epilepticus

Stavropoulos, Ioannis; Khaw, Jien-Yi; Valentin, Antonio

doi:10.3389/fneur.2023.1195844

Cited by 8 publications

(2 citation statements)

References 72 publications

(118 reference statements)

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“…Neuromodulation with vagus nerve stimulators, deep brain stimulators, or transcranial magnetic stimulation has also been described. 56 In selected appropriate cases, resective epilepsy surgery may be effective. However, the level of evidence for these treatments is limited to case series.…”

Section: Refractory Status Epilepticus and Super-refractory Status Ep...mentioning

confidence: 99%

“…However, the level of evidence for these treatments is limited to case series. 56,57 The management of RSE requires a comprehensive evaluation for treatable etiologies, including CNS imaging, CSF analysis, toxicology screen, and basic hematologic and chemistry blood panels. Autoimmune encephalitis, including NMDA receptor antibody encephalitis, is an important treatable cause to consider.…”

Section: Refractory Status Epilepticus and Super-refractory Status Ep...mentioning

confidence: 99%

See 1 more Smart Citation

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.

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Section: Refractory Status Epilepticus and Super-refractory Status Ep...mentioning

confidence: 99%

Section: Refractory Status Epilepticus and Super-refractory Status Ep...mentioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Autoimmune‐associated seizure disorders

Smith,

Budhram,

Geis

et al. 2024

Epileptic Disorders

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With the discovery of an expanding number of neural autoantibodies, autoimmune etiologies of seizures have been increasingly recognized. Clinical phenotypes have been identified in association with specific underlying antibodies, allowing an earlier diagnosis. These phenotypes include faciobrachial dystonic seizures with LGI1 encephalitis, neuropsychiatric presentations associated with movement disorders and seizures in NMDA‐receptor encephalitis, and chronic temporal lobe epilepsy in GAD65 neurologic autoimmunity. Prompt recognition of these disorders is important, as some of them are highly responsive to immunotherapy. The response to immunotherapy is highest in patients with encephalitis secondary to antibodies targeting cell surface synaptic antigens. However, the response is less effective in conditions involving antibodies binding intracellular antigens or in Rasmussen syndrome, which are predominantly mediated by cytotoxic T‐cell processes that are associated with irreversible cellular destruction. Autoimmune encephalitides also may have a paraneoplastic etiology, further emphasizing the importance of recognizing these disorders. Finally, autoimmune processes and responses to novel immunotherapies have been reported in new‐onset refractory status epilepticus (NORSE) and febrile infection‐related epilepsy syndrome (FIRES), warranting their inclusion in any current review of autoimmune‐associated seizure disorders.

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Übersicht über erstmaliges Auftreten eines therapierefraktären Status epilepticus: aktuelle Konzepte, Diagnose und Behandlung

Wickström

2023

Clin Epileptol

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New-onset refractory status epilepticus (NORSE) is a rare and devastating condition presenting with refractory status epilepticus and often evolving into super-refractory status epilepticus. The poor outcome with a significant mortality rate and a high rate of morbidity among survivors of NORSE warrants awareness and early identification of the condition so as to initiate appropriate investigations and management. Although the pathophysiological mechanisms are unknown, inflammatory mechanisms including activation of innate immunity are likely involved. Treatment should therefore include aggressive escalation of antiseizure medications followed by early initiation of a ketogenic diet and immunomodulation. First-line immunotherapy should be initiated within 72 h of seizure onset, with a ketogenic diet and second-line immunomodulation being started in the first week if seizures remain. This article aims to review current knowledge on NORSE and to highlight specific areas including recent consensus definitions and Delphi-based recommendations as well as open registries for future research.

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Neuromodulation in new-onset refractory status epilepticus

Cited by 8 publications

References 72 publications

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Autoimmune‐associated seizure disorders

Übersicht über erstmaliges Auftreten eines therapierefraktären Status epilepticus: aktuelle Konzepte, Diagnose und Behandlung

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